Global Challenge: Non-Communicable Disease

This paper reviews The Global Action Plan for the Prevention and Control of Non-Communicable Disease (NCD) during 2013-2020. It discusses the evidence, lessons learned, key issues, global actors, milestones, principles, and Sustainable Development Goals (SDGs) related to NCD policy.

Running head: GLOBAL CHALLENGE NON-COMMUNICABLE DISEASE
Global Challenge: Non-Communicable Disease
Name of the Student
Name of the University
Author Note

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Introduction
The following paper will review The Global Action Plan for the Prevention and
Control of Non-Communicable Disease (NCD) during the tenure of 2013 to 2020 by the
World Health Organisation (2013). The review will be done based on the problem and
priorities highlighted in the policy along with the policy action framework including
challenges and recommendation.
Evidence that underpins the policy making
The Global Action Plan for the Prevention and Control of Non-Communicable
Disease (NCD) during the tenure of 2013 to 2020 by the World Health Organisation (2013)
was designed with a vision to free the world from the burden of the non-communicable
disease (NCD). This vision is based on the past 10 years of research conducted over the mode
development and management of NCD followed by difference in the rate of occurrence of the
NCD across difference socio-economic group. The goal of this global health policy is to
reduce preventable and avoidable mortality, morbidity and disability of NCD by application
of multisectoral collaboration and effective cooperation at local, regional, national and at the
global levels. The outcome will be highest attainable standards of the health and wellbeing
and productivity at every age along with recovering the barrier of socio-economic
determinants of health causing the disease burden (World Health Organisation 2013).. The
main over-reaching principles of this policy include life-course approach, effective
empowerment of people and the communities, application of the evidence-based practice for
the recovery of the NCD, promotion and universal health coverage. Other principle includes
universal health coverage, application of human right approach, equity-based approach,
multi-sectoral action approach and national action and international cooperation with the
promotion of solidarity (World Health Organisation [WHO] 2013).

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Lessons learnt from addressing NCD within the last 10 years
The main lessons learnt while addressing the NCD management during the last 10
years includes NCD are preventable under the proper application of the healthy lifestyle
habits. Unhealthy lifestyle habits like increased level of smoking, consumption of alcohol,
lack of physical activity, sedentary lifestyle and consumption of junk food is the main reason
behind the development of the non-communicable diseases during the later stages of life like
type 2 diabetes mellitus and cardiovascular disease. Another lesson that has been learnt while
addressing NCD includes people who belong from the poor socio-economic background are
more prone towards the development of the NCD. This is because lack of proper health
literacy, lack of access of proper healthcare and lack of employment.
Key issues that need to be addressed
The principle issues that needed to be addressed at current moment include reduction
in the risk of premature mortality arising from the cardiovascular disease, diabetes, cancer
and chronic respiratory disease by the effective implementation of the health lifestyle habits
(WHO 2013). Ding et al. (2016) are of the opinion that the reduction in the harmful use of the
alcohol and smoking of tobacco must also be addressed in a priority level in order to reduce
the chances of the developing NCD. This is because increased consumption of alcohol during
the early years of life increases the threat of developing cardiovascular diseases, CPOD and
type 2 diabetes mellitus. WHO (2013) also identified reduction in salt and sodium in the diet
plan of mass as increased intake of the salt in the diet increase the predisposition of
developing chronic hypertension. Apart from healthy lifestyle interventions, WHO also give
preference of increase in the health literacy about the NCD diseases and factors affecting the
development of NCD so that the community dwelling mass must take part in the health
screening programs in order to aid in the process of early identification of the disease . Health

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literacy must also be undertaken in order to increase the therapy adherence along with the
increase in the disease self-management skills. Mendenhall et al. (2017) highlighted in their
study that increase in the knowledge of the disease self-management skills help in improving
the effective management of type 2 diabetes mellitus (T2DM). Initial prevention of the NCD
failed to cover the effective promotion of the health literacy and thus hampering a
comprehensive prevention of the NCD.
Key global actors and leadership in NCD policy
Vaidya (2018) is of the opinion that an ultimate guardian of health of a particular race
or population, residing at any particular geographic location is the government. Thus the
main global actors for the effective implementation of the NCD prevention policy in
respective country are their government. The role of the government is to prove the quality
leadership in order to ensure proper institutional, legal, financial and other associated service
arrangements for the effective prevention and control of NCD at the grass root level. Diem et
al. (2016) further highlighted that the in order to apply evidence-based practice under the
public health settings in order to prevent the occurrence of the NCD, it is the duty of the
leader to handle both behaviour related factors while managing the underlying social and
economic conditions. Thus in order to effectively handle the behaviour related factor of the
public and to promote effective health education among the mass, the nurses both the
community health nurses and the mental health nurses are regarded as the main leaders
behind the comprehensive implementation of the NCD. Beside the nurses, the public health
officers in the respective countries must also work in unison to address the challenges in the
evidence-based decision making process and thereby helping to implement the capacity
building efforts (Diem et al. (2016). WHO (2013) global health policy for the prevention of
the NCD thus includes public health leaders from the different countries along with leaders in

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the nursing profession. The role of these leaders is to conduct effective screening of health for
the early identification of the disease development and effective implementation of the early
intervention.
Key milestones in policy formulation and implementation
The key milestones that are undertaken for the effective formulation of the policy is
include promotion of the health lifestyle habits through health literacy will help to reduce the
chances of occurrence of the NCD or decrease in the severity of the NCD. The study
conducted by Hanson and Gluckman (2011) under the United States settings highlighted the
effective improvement of the lifestyle interventions will be helpful in reducing the mortality
and morbidity of mass arising from cardiovascular disease, T2DM, cancer and COPD.
Tuomilehto, Schwarz and Lindström (2011) also reported similar results while conducting
study of healthy lifestyle interventions over the Australia population towards the prevention
of the T2DM. The main NCDs of choice that are main focus of this global health policy
includes COPD, cancer, T2DM and CVD. WHO (2013) global policy was also framed by
taking the reference of the milestones highlighted in the Report of the 2010 Global Survey
published by the WHO. This survey report highlighted that proper application of the healthy
lifestyle interventions can be helpful in improving the overall quality of life of the people
residing by reducing the rate of occurrence of the NCDs. This report also laid to the
foundation of the policy development of the NCD prevention.
Principles and Approaches used in NCD policy
First approach used by NCD policy by WHO (2013) is effective control of NCD by
strengthening the international cooperation and health advocacy. Increase in the level of
health advocacy will help in the promotion of the empowerment of the service users and
thereby promotion self-management skills of the disease (Nutbeam 2017). The second

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principle of the policy includes promotion of the leadership governance and multisectoral
actions and partnership across several countries in order promote comprehensive prevention
of the NCD. The leadership governance helps in the promotion of the health advocacy and
thus promoting health awareness. Leadership governance is mainly undertaken by the nursing
professionals who play a key role in the promotion of health literacy and at the same time
helps in the promotion of the community health interventions for NCD prevention (Haw et al.
2017). The third principle includes reduction of the modifiable risk factors for the NCD
development by improving the social determinates of health. This approach is based on the
fact that the people who are residing under the poor socio-economic status like the indigenous
people are more likely to develop NCD due to their poor life style condition, lack of health
literacy, poor healthcare access and lack proper housing structure. Improvement of the social
determinants of health will help to reduce the health inequality and thereby helping in
comprehensive disease prevention (Walker, Williams and Egede 2016). Fourth principle is
re-orientation of the healthcare service by the application of the person centred care plan in
order witness effective prevention and control of NCD. This approach is mainly guided by
the primary health prevention framework framed by WHO under the name of the Ottawa
Charter of Health Prevention. As per the Ottawa Charter of Health prevention, re-orientation
of the healthcare service will help to achieve new milestones in disease prevention.
Moreover, use of the person-centred care plan is one of the most cherished evidence-based
practice in healthcare profession (World Health Organization 2019). Fifth principle is
promotion of high quality research in the prevention of the NCD. Sixth principle of WHO
global NC policy include monitoring of the trends and determinants of the NCD in order to
highlight the current trend in the epidemiology and evaluation of the progress in policy in the
effective prevention of the disease (WHO 2013).

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NCDs in the Sustainable Development Goals (SDGs)
According to the WHO (2019), the SDGs for the effective promotion of the NCD
include reduction in the premature mortality occurring out of NCD. Second SDGs include
strengthening the responses in order to reduce the controllable consumption of alcohol in
order to reduce the chances of developing hypercholesterolemia and cirrhosis of liver that
eventually lead to the development of T2DM and CVD. The third SDG will be to promote
universal health coverage across difference population in a cost effective rate. The fourth
SDG is strengthening and effective implementation of the WHO Framework Convention on
Tobacco Control (FCTC). This will help to reduce the smoking of tobacco among across
diverse population like the youth, indigenous population and the people who are suffering
from depression. The fifth SDGs is to promote the effective research and vaccines along with
advanced grade medicines for NCDs prevalent in the developing countries like India,
Srilanka. The sixth and the last intervention for SDG include increase access to the affordable
medicines and vaccines and this will be helpful for the people who are residing under the
poos socio-economic background and are more vulnerable in developing NCDs (WHO,
2019).
Global Targets
The global targets of the Global Action Plan for the Prevention and Control of NCDs
2013-2020 include reduction in the overall mortality and morbidity arising out of NCD by
25% globally. Cohen et al. (2017) are of the opinion that one of the important markers for the
improvement of the health condition of the population is the reduction of the rate of the
mortality and morbidity arising out of the NCD. This reduction in the mortality and morbidity
rate will be helpful in the identification of the effectiveness of the overall health promotion
principles and approaches. Reduction in the mortality and morbidity arising out of the NCD

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will also act as an important indicator for the decrease in the overall disease outcome (Cohen
et al. 2017).
The role of global versus national policy and the importance of national policy
Commonly, global health policy and governance focuses on the global health policy
construct and its related problems regarding legitimise the resources, knowledge and its
association with the solution. To describe better, it connects a country’s work on global
policy across the global health sector rather than the national policy sector which may not
have a leading implementation role in that country (Jones, Clavier and Potvin 2017). On other
words, it can be stated that the global policy does not really represent a country’s vision on a
particular health policy.
On the contrary, national health policies, plan and strategies plays a vital role on a
country’s vision related to the health policy, policy strategies and direction. National health
policy is important for a country’s health care system because it can help embolden the
primary health coverage of a country’s primary health care, person- centred care as well as
public health regarding the health policies. In addition to that, it can also steer and guide the
entire health sector rather than just control and commanding the public sector (WHO, 2019).
Furthermore, a national health policy can also serve beyond the public health care system and
it can tackle the related issues like social determinants of health system and interconnection
between the other sectors. As every country’s socio- demographic is different, it is not
prudent to implement a global policy to all the countries as there is a vast difference in socio-
demographic between developed and developing country. Therefore, it can be stated that the
global policy direct the guidelines for a particular health issue whereas national policy is
requires to customise the policy according to the country’s socio- economic situation (WHO,
2019)

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Coordination and monitoring mechanisms
Coordination mechanism for the Global Action Plan for the Prevention and Control of
NCDs 2013-2020 was established in the year 2014 (WHO, 2019). This is the first time WHO
have developed an instrument with the aim of aiding engagement between the cross-
sectional collaboration and multi stakeholder for the control and prevention of NCDs. Among
them, multisectoral action plan takes the primary stage, as it is responsible for the sustainable
development goal that influences the people’s health with relation to the environmental,
social, and commercial determinants. Owing to the reason that these determinants resides
outsides the heath sector, “whole-of-society” and “whole-of-government” approach should be
adopted for the monitoring and coordination purpose (WHO, 2019). Responsibility has to be
shared among the different stakeholder as it is in paramount importance for the prevention
and control of the NCDs. United Nation’s has conducted three high level meeting between all
the stakeholders regarding the importance of shared responsibility. Multisectoral approach is
the method by which WHO will implement its effort among its member states to influence
and scale up the cost effective and high impact method needed to tackle NCDs. In relation to
the governance of NCDs, WHO also has created a roadmap like Montevideo Roadmap 2018-
2030 (WHO, 2019).
Key documents on NCD policy
WHO has separate documentation about the NCD reports and other policy records
about separate countries. Each documentation of the NCD policy is tabulated in separate
format in an alphabetical order. The highlight of the documentation of the NCDE policy as
made by WHO at the global level include integrated effect of the NCDE policies. It also
focus on how it has helped in the reduction of the NCD throughout the world. This is
followed a separate documentation as per the different NCD like the cardiovascular disease

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polices, cancer policies, diabetes policies, chronic respiratory disease policies. Apart from
the separate disease policy, the WHO (2015) has records for the tobacco policies, diet
policies and other salt polices that are important in the prevention of the NCD. The
documentation mainly covers the effectiveness of the proposed interventions towards
controlling the rate of occurrence of any disease for example how lifestyle interventions of
daily practice of the physical activity helps in reducing the rate of occurrence and the severity
of T2DM. Effective documentation is helpful because it helps to ascertain the overall
effectiveness of the proposed interventions based on the reduction of mortality and morbidity
of NCD along with the reported cases of hospitalization occurring as a result of the
modifiable risk factors. These effective documentation further helps in bringing change in the
policy planning for more refined health results (Arena, et al. 2015).
Challenges in formation and implementation of NCD policies
The main challenges in the formation of polices at the global level a policy that is
applicable under the Australian context (a developed country), might not be applicable under
the under the Indian sub-continent which is a developing country. Weeramanthri and Bailie
(2015) are of the opinion that a public health policy is practiced and implemented at several
levels. These levels include local, regional, national and at the international level. Different
nations have different health care needs and different socio-economic crisis and depending on
that crisis, the healthcare policy needs to be implemented. Moreover, epidemiology of the
disease progression changes with time and thus a policy must be reframed within every five
years in order to get the maximum benefits. One of the barriers behind the implementation of
the policy is the cultural and linguistic barrier. For example, the Aboriginal people residing in
Australia belongs to culturally and linguistically diverse community (CLAD) such that the a
complete different health education approach under the supervision of the CLAD nurse is

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required to be undertaken in order to attain comprehensive health promotion. Moreover, the
diet plan for the promotion of the health lifestyle must be made in such a manner such that it
is culturally competent. This culturally competent policy structure was not previous
implemented but during the course of time, heath equity is given importance and thereby
introducing change in the policy planning (Weeramanthri and Bailie 2015).
Recommendations for the way forward
Further recommendation for way forward will include designing of the effective diet
plan and with education of the people about the effectiveness of proper diet in the prevention
of the disease. This education will be specific towards age related dietary requirement and
how the diet style must be changed based on the sedentary more of life, total calorific
requirement of the body and body mass index. Hyseni et al (2017) are of the opinion that diet
is one of the important factor behind the development of NCD like T2DM and CVD. Proper
regulation of diet plan based on age, gender and BMI along with inclusion of the fresh fruits
and seasonal vegetables will help the body with proper antioxidants that will eventually help
to improve the immune power of the body and thereby helping to reduce the occurrence of
NCD.
Conclusion
Thus from the above discussion it can be concluded that Global Action Plan for the
Prevention and Control of Non-Communicable Disease (NCD) during the tenure of 2013 to
2020 by the World Health Organisation (2013) is an important policy at the global level that
is required to be undertaken in order to reduce the rate of occurrence of the NCD. The main
approach that is being taken by the policy is change in the lifestyle factors like diet, physical
exercise in order to reduce the modifiable risk factors behind the disease development. One
of the important aspect of this global health policy by WHO is that it has evolved during the

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course of time and have utilised principle like leadership governance, disease advocacy,
person-centred care plan in order to promote a comprehensive health promotion plan. Further
improvement in the policy must be done in sectors like dietary education to the mass.

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