Comprehensive Global Monitoring Framework for Noncommunicable Diseases, Including a Set of Indicators

Annex 4: Comprehensive Global Monitoring Framework for Noncommunicable Diseases, Including a Set of Indicators

  Table 1 presents a set of 25 indicators. The indicators, covering the three components of the global monitoring framework, are listed under each component. The comprehensive global monitoring framework, including the set of 25 indicators, will provide internationally comparable assessments of the status of noncommunicable disease trends over time, and help to benchmark the situation in individual countries against others in the same region, or in the same development category. In addition to the indicators outlined in this global monitoring framework, countries and regions may include other indicators to monitor progress of national and regional strategies for the prevention and control of noncommunicable diseases, taking into account country- and region-specific situations.

  Table 1. Indicators to monitor trends and assess progress made in the implementation of strategies and plans on noncommunicable diseases

  Mortality and morbidity

  1. Unconditional probability of dying between ages 30 and 70 years from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases.

  2. Cancer incidence, by type of cancer, per 100 000 population. Risk factors

  Behavioural risk factors:

  3. Harmful use of alcohol: Total (recorded and unrecorded) alcohol per capita (15+ years old) consumption within a calendar year in litres of pure alcohol, as appropriate, within the

  national context. 4. Harmful use of alcohol: Age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appropriate, within the national context. 5. Harmful use of alcohol: Alcohol-related morbidity and mortality among adolescents and adults, as appropriate, within the national context. 6. Age-standardized prevalence of persons (aged 18+ years) consuming less than five total

  13. Age-standardized prevalence of raised blood glucosediabetes among persons aged 18+ years (defined as fasting plasma glucose value ≥7.0 mmolL (126 mgdl) or on medication for raised blood glucose).

  14. Age-standardized prevalence of raised blood pressure among persons aged 18+ years (defined as systolic blood pressure ≥140 mmHg andor diastolic blood pressure ≥90

  mmHg); and mean systolic blood pressure. 15. Prevalence of overweight and obesity in adolescents (defined according to the WHO growth reference for school-aged children and adolescents, overweight – one standard deviation body mass index for age and sex, and obese – two standard deviations body mass index for age and sex). 16. Age-standardized prevalence of overweight and obesity in persons aged 18+ years (defined as body mass index ≥25 kgm² for overweight and body mass index ≥ 30 kgm² for obesity). 17. Age-standardized prevalence of raised total cholesterol among persons aged 18+ years (defined as total cholesterol ≥5.0 mmolL or 190 mgdl); and mean total cholesterol.

  National systems response

  18. Proportion of women between the ages of 30–49 screened for cervical cancer at least once, or more often, and for lower or higher age groups according to national programmes or

  policies. 19. Proportion of eligible persons (defined as aged 40 years and over with a 10-year cardiovascular risk ≥30, including those with existing cardiovascular disease) receiving drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. 20. Availability and affordability of quality, safe and efficacious essential noncommunicable disease medicines, including generics, and basic technologies in both public and private facilities. 21. Vaccination coverage against hepatitis B virus monitored by number of third doses of Hep-B vaccine (HepB3) administered to infants. 22. Availability, as appropriate, if cost-effective and affordable, of vaccines against human policies. 19. Proportion of eligible persons (defined as aged 40 years and over with a 10-year cardiovascular risk ≥30, including those with existing cardiovascular disease) receiving drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. 20. Availability and affordability of quality, safe and efficacious essential noncommunicable disease medicines, including generics, and basic technologies in both public and private facilities. 21. Vaccination coverage against hepatitis B virus monitored by number of third doses of Hep-B vaccine (HepB3) administered to infants. 22. Availability, as appropriate, if cost-effective and affordable, of vaccines against human

  Table 2. A set of voluntary global targets for the prevention and control of noncommunicable diseases

  Mortality and morbidity

  Indicator

  Premature mortality from noncommunicable disease

  Target 1: A 25 relative reduction in

  • Unconditional probability of dying between ages 30

  overall mortality from cardiovascular

  and 70 from cardiovascular diseases, cancer,

  diseases, cancer, diabetes, or chronic

  diabetes, or chronic respiratory diseases.

  respiratory diseases.

  Risk factors

  Indicator

  Behavioural risk factors Harmful use of alcohol ii

  • Total (recorded and unrecorded) alcohol per capita

  Target 2: At least a 10 relative

  (15+ years old) consumption within a calendar year

  reduction in the harmful use of

  in litres of pure alcohol, as appropriate, within the

  alcohol iii , as appropriate, within the

  national context.

  national context.

  • Age-standardized prevalence of heavy episodic

  drinking among adolescents and adults, as appropriate, within the national context.

  • Alcohol-related morbidity and mortality among

  adolescents and adults, as appropriate, within the national context.

  Physical Inactivity

  Target 3: A 10 relative reduction in

  • Prevalence of insufficiently physically active

  prevalence of insufficient physical

  adolescents defined as less than 60 minutes of

  • Prevalence of current tobacco use among

  Target 4: A 30 relative reduction in

  adolescents.

  prevalence of current tobacco use in

  • Age-standardized prevalence of current tobacco

  persons aged 15+ years.

  use among persons aged 18+ years.

  Biological risk factors:

  Raised blood pressure

  Target 6: A 25 relative reduction in the • Age-standardized prevalence of raised blood prevalence of raised blood pressure or

  pressure among persons aged 18+ years (defined as

  contains the prevalence of raised blood

  systolic blood pressure od pressure according to

  pressure according to national

  national circumstances.quiv

  circumstances. Diabetes and obesity v

  Target 7: Halt the rise in diabetes and

  • Age-standardized prevalence of raised blood

  obesity.

  glucosediabetes among persons aged 18+ years (defined as fasting plasma glucose value ≥ 7.0 mmolL (126 mgdl) or on medication for raised blood glucose.

  • Prevalence of overweight and obesity in

  adolescents (defined according to the WHO growth reference for school-aged children and adolescents, overweight – one standard deviation body mass index for age and sex and obese – two standard deviations body mass index for age and sex).

  • Age-standardized prevalence of overweight and

  obesity in persons aged 18+ years (defined as body mass index ≥25 kgm2 for overweight and body mass index ≥30 kgm2 for obesity).

  National system response

  Indicator

  Target 9: An 80 availability of the

  • Availability and affordability of quality, safe and

  affordable basic technologies and

  efficacious essential noncommunicable disease

  essential medicines, including generics,

  medicines, including generics, and basic

  required to treat major

  technologies in both public and private facilities.

  noncommunicable diseases in both public and private facilities.

  TABLE OF TERMS

  Unhealthy Diet

  Diet consisting of varied foods, excessive sugar and fat and which do not follow a balanced nutritional proportion, and consumption of food containing dangerous ingredients that carry risk of causing NCD.

  Double burden of

  Burden carried by the state and civil society due to consistently high

  diseases

  prevalence of communicable diseases and concurrent increase of prevalence of noncommunicable diseases and which have become a public health challenge.

  NCD Risk Factors

  Items or variables that can cause noncommunicable disease in a person. Some risk factors can be modified, such as lifestyle, smoking, unhealthy diet, etc., while others cannot be modified such as sex, age, and genetics.

  Common NCD Risk

  Risk factors that can become the cause of a number of diseases

  Factors

  categorized as major NCDs.

  Tier One Healthcare

  Healthcare facilities providing primary healthcare, whether state-owned

  Facility

  (PUSKESMAS) or privately owned (clinics).

  Health in All Policies

  A strategy aimed at making the health aspect to be taken into account by

  (HiAP)

  sectors that affects public health.

  Smoke free Zone (KTR)

  Room or area declared as prohibited for smoking or the production, sale, or advertisement andor promotion of tobacco products, in accordance with Government Regulation 109 of 2012. KTR include: 1) healthcare facilities; 2) education facilities; 3) children playground; 4) religious facilities; 5) public transport; 6) workplace; and 7) other designated public areas.

  Availability of essential

  List of minimum medicines and health equipment availbe at healthcare

  NCD medicine and

  facilities to manage major NCD cases.

  technology Dangerous

  Alcohol consumption level exceeding 5 standards per day. One standard

  consumption of alcohol

  is equivalent to one glass of beer (285 ml), 120 ml of wine or 30 ml of is equivalent to one glass of beer (285 ml), 120 ml of wine or 30 ml of

  a week. Heavy physical activities include drawing water from a well, hiking, running, cutting down trees, tilling the field, etc. Moderate physical activities include sweeping, mopping, cleaning furniture, walking, etc.

  Integrated NCD Services An approach based on major NCD risk factor for early detection and

  monitoring of NCD risk factors that is integrated into and implemented through the Posbindu PTM in the community, and integrated hypertension and diabetes related services and other specialized NCD services at primary healthcare facilities.

  This constitute an adaptation of the WHO-PEN (Package Essensial of NCDs Intervention) at primary healthcare facilities.

  Smoker

  A person who smokes or chews tobacco on a daily or occasional basis.

  Obesity

  Chronic condition due to accumulation of fat in the body that exceeds the health threshold. Determination of a person being obese may utilize the use of Body Mass Index (BMI) calculation.

  Major NCDs

  Chronic disease that is non-infectious or non-transmissible, and which last for long periods of time and progress slowly. According to WHO, the four major NCDs are: 1) cardiovascular disease (heart disease and stroke), 2) cancer, 3) chronic pulmonary disease (such as chronic pulmonary obstruction and asthma), and 4) diabetes mellitus. The four major NCDs have common risk factors.

  Integrated NCD

  Integrated early detection of common risk factors of major NCDs

  Education Post

  (cardiovascular disease, diabetes, chronic pulmonary obstruction and

  (Posbindu PTM)

  cancer) managed by community groups, organizations, industries, campus, etc.

  Sustainable

  Agenda for sustainable development up to 2030 agreed globally through

  Development Goals

  the UN Assembly representing 193 countries on 25 September 2015. The

  (SDGs) 2030

  agenda contains 17 goals, 169 targets and 304 indicators, one of which is NCD. Goal 1 through 6 have direct relationship with disparity in health, particularly in developing countries.

  i Individual fatty acids within the broad classification of saturated fatty acids have unique biological properties and health effects that can have relevance in developing dietary recommendations. ii

  Countries will select indicator(s) of harmful use as appropriate to national context and in line with WHO’s global strategy to reduce the harmful use of alcohol and that may include prevalence of heavy episodic drinking, total

  alcohol per capita consumption, and alcohol-related morbidity and mortality among others. iii In WHO’s global strategy to reduce the harmful use of alcohol the concept of the harmful use of alcohol

  encompasses the drinking that causes detrimental health and social consequences for the drinker, the people around the drinker and society at large, as well as the patterns of drinking that are associated with increased risk of adverse health outcomes. iv v WHO’s recommendation is less than 5 grams of salt or 2 grams of sodium per person per day.

  Countries will select indicator(s) appropriate to national context.

  Reference

  • Bappenas (National Development Planning Agency) (2015). Rencana Pembangunan Jangka

  Menengah Nasional (National Medium Term Development Plan) 2015-2019. Jakarta, 2015 • Indonesia Ministry of Health (2015). Rencana Strategis Kementerian Kesehatan (Ministry of Health

  Strategic Plan) 2015-2019. Jakarta, 2015 • World Health Organization (2013). Global Action Plan for the Prevention and Control of Non

  Communicable Diseases 2013-2030. Geneva, 2013 • World Health Organization-SEARO (2013). Action Plan for the Prevention and Control of Non

  Communicable Diseases in South-East Asia 2013-2030. New Delhi, 2013 • World Economic Forum (2015). Economics of Noncommunicable Diseases in Indonesia. Geneva,

  2015. • Department of Health of South Africa (2013). Strategic Plan for the Prevention and Control of

  Noncommunicable Diseases in South Africa 2013-17. • World Health Organization and World Economic Forum (2011). From Burden to “Best Buys”:

  Reducing the Economic Impact of Noncommunicable Diseases in Low- and Middle-Income Countries. Geneva, 2011.

  • Indonesia Ministry of Health (2011). Strategi Nasional Penerapan Pola Konsumsi Makanan dan