Page 0019

CANCER CONTROL PLANNING

18 CANCER CONTROL 2014

inactivity; the major risk factors for the most common NCD

types: cancer, cardiovascular diseases, stroke, diabetes and

chronic obstructive pulmonary diseases.

Comparing the NCD burden and priorities

In a number of high-income countries (e.g., Australia, Canada,

France, Italy, Spain, Norway, Sweden, Switzerland, Israel,

Japan and the Republic of Korea), life

expectancy at birth now exceeds 80

years. Perhaps contrary to common

perception, the more highly developed

regions of the world do not exhibit the

highest age-standardized death rates of

NCDs (Group II in Figure 3).3 If the

underlying population age structure

was equal - as seen by comparing

the age-standardized and nonstandardized (crude)

death rates in

Figure 3, Africa would have the highest

NCD mortality worldwide, in relative

terms. It is therefore essential to bear in

mind that low- and middle-income

countries often experience a "double

burden" of disease: still rather high

death rates of infectious diseases

alongside a high and ever-increasing

burden from the major NCDs (Figure 3).

There are different ways to establish

priorities and achievable targets in the

prevention of NCDs and the focus of

WHO has been on common, modifiable

risk factors shared across the

spectrum of key diseases (Figures 1 and

2). In addition, high-priority medical

interventions had to be feasible and

potentially cost-effective in primary

care settings in any country, i.e., socalled best-buys.6

Obviously, best-buys

vary markedly from one country to

another according to the variable

impact of different NCDs and, in

particular, individual cancer sites.

Cancer: A multifaceted disease

and a major cause of death

Cancer is a complex disease with its

own epidemiological transition: as

countries move towards high levels of

human development, cancers associated with infection and

poverty (e.g. cancers of the stomach, liver and cervix) are

surpassed in their magnitude by those more associated with

affluence (e.g. cancers of female breast, prostate and colon).

In high-income countries, the control of infectious disease

and the lowering of death rates of cerebrovascular disease

and stroke, have led to cancer becoming increasingly one of

Drug therapy

and counselling

50% coverage

Essential NCD

medicines and

technologies

80% coverage

Diabetes/

obesity

0% increase

Raised blood

pressure

25% reduction

Tobacco use

30% reduction

Salt/sodium

intake

30% reduction

Physical

inactivity

10% reduction

Harmful use

of alcohol

10% reduction

Premature

mortality from NCDs

25% reduction

Set of 9 voluntary global NCD targets for 2025

Formal meeting of Member States to conclude the work on the comprehensive

global monitoring framework including indicators and a set of voluntary targets

for the prevention and control of NCDs (Geneva, 5-7 November 2012)

Mortality and morbidity

Risk factors for NCDs

National system response

Figure 1: Voluntary global NCD targets for 2025

Source: World Health Organization

The NCD Alliance: Putting non-communicable diseases on the global agenda. (http://ncdalliance.org/campaigns)

Formal meeting of Member States to conclude the work on the comprehensive

global monitoring framework including indicators and a set of voluntary targets

for the prevention and control of NCDs (Geneva, 5-7 November 2012)

Global monitoring framework

Harmful use of alcohol (3)

Low fruit and vegetable intake

Physical inactivity (2)

Salt intake

Saturated fat intake

Tobacco use (2)

Raised blood glucose/diabetes

Raised blood pressure

Overweight and obesity (2)

Raised total cholestrol

Risk factors

25 Indicators

Total number of related indicators in brackets

Cervical cancer screening

Drug therapy and counseling

Essential NCD medicines

and technologies

Hepatitis B vaccine

Human Papilloma virus vaccine

Marketing to children

Access to palliative care

Policies to limit saturated

fats and virtually

eliminate transfats

National system response

Unconditional probability

of dying between ages 30 and 70

years from cardiovascular

diseases, cancer, diabetes or

chronic respiratory diseases

Cancer incidence by type of Cancer

Mortality and morbidity

Figure 2: Global monitoring framework

Source: World Health Organization.

The NCD Alliance: Putting non-communicable diseases on the global agenda. (http://ncdalliance.org/campaigns)

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