The changes brought about by demographic and epidemiologic transition have had a profound impact on the health patterns in countries of the Gulf Region.
Chronic diseases such as cardiovascular, diabetes, cancer and respiratory conditions are rising dramatically in the Gulf Region. Currently, 45% of the region’s disease burden is due to noncommunicable diseases. It is expected that this burden will rise to 60% by the year 2020.
It has become very evident from the World Health Organization Report that the mortality, morbidity and disability attributed to the main non-communicable diseases currently form around 60% of total deaths and 47% of the global burden of diseases. It is expected that these two rates will rise to 73% and 60% respectively by the year 2020. What adds to the graveness of this situation is that 66% of deaths attributable to NCDs take place in the developing countries, specially in persons at the productive age.
CVD and diabetes are emerging as the single leading cause of mortality in the Gulf. The enormous burden caused, in terms of suffering and health costs is escalating.
Diabetes and hypertension are the 2 major health problems facing the Gulf region, the incidence being 15-28 % for diabetes and 26% for hypertension.
Health care systems must guard against the fragmentation of services. Care for NCDs needs integration to ensure shared information across setting and providers, this means setting priorities for screening, early detection prioritising surveillance, and management to be applied and followed among Gulf area, through community - based programme as well as PHC team training on:
- Evidence-based, clinical management of chronic conditions.
- Organizational factors that support the provision of care for patients with chronic conditions.
- A proven methodology for accelerating health care improvement in PHC.
Primary prevention, based on comprehensive _population-based programmes, is the most cost-effective approach to contain this emerging epidemic. Therefore, action to reduce these major NCDs should focus on preventing and controlling the risk factors in an integrated manner. Intervention at all levels of society, from communities to governments, private organizations and nongovernmental groups, is essential for prevention since the risk groups are entrenched in the framework of society influenced by many areas of national policy.
The WHO strategy the challenges as well as the opportunities in addition to the importance of lacking the common avoidable biological risk factors (most importantly hypertension – hypercholesterolemia – overweight) which form – together with related behavioral risks such as unhealthy diet – inactivity and tobacco control – the most important risks for noncommunicable diseases which are the main causes of death, namely cardiovascular diseases, cancer-chronic obstructive pulmonary diseases and type II diabetes.
In this respect, and to promote the control of these diseases, The Executive office circulated the recommendations issued by the various international fora Geneva, Sha’ban 1422H (November 2001), Shanghai Sha’ban 1423H (November 2002) stressing the need for more support to the regional networks to combat non- communicable diseases and putting an emphasis on the following 4 points:
1. Health services development.
2. Defining risk factors and how to face them.
3. Surveillance of these diseases.
4. Continuous research and evaluation.
In this context, a country consultative meeting was held in Beirut 25-27/4/1423H (5-7 July 2002) under the sponsorship of the WHO/EMRO. The General Director of the EB participated in this meeting as an expert and submitted a report to their excellencies the Ministers of Health requesting the MOH to assign a focal point or a department to follow on this issue as well as surveillance and evaluation of programs of such group of diseases together with coordination with the regional network (EMAN). H.E. addressed very important concepts related to the adoption of new health programs or initiatives which are evidence-based in terms of effectiveness in controlling NCDs, such as shared care, specialized mini clinics, etc.
Resolution # 15 issued in the 54th conference (held in Abu Dhabi, January 2003) affirmed the establishment and operation of such network and the specialized department of control of non- communicable diseases.
This issue was discussed in the executive body in its 58th meeting Safar 1424 (April 2003) where recommendation # (9) was issued stressing on reviewing surveillance, control and evaluation systems, adoption of risk indicators concept to such group of diseases and defining a concerned body in the MOH in each member state to be responsible for NCDs.
In this respect resolution # 9/56 Doha, Qatar, Dhu Al-Qa’dah 1424H (January 2004) was issued, whereby the regional advisor for the EMR for control or non-communicable diseases (EMAN Coordinator) is requested to formulate a comprehensive integrated work plan for the Gulf States about their role and requirements to be linked to this network according to phased workplan.
Preliminarily, it was agreed on the general framework of this plan in the 60th meeting of the E. Body (April 2004) where recommendation # (4) was issued involving the following:
1- Supporting and developing the current divisions/departments concerned with control of NCDs in the MOHs as well as establishing specialized departments or divisions in a high structural position in the MOH in those countries which do not have such departments or divisions.
2- Approval on the general framework for the workplan proposed by the EMRO regional advisors for control of NCDs (coordinator of EMAN) taking in consideration the liberty of application and field implementation to suit the local conditions and facilities available in each of the member states.
3- Assigning national and Gulf committees (concerned with control of NCDs) to prepare evidence-based guidelines for risk factors in coordination with the EMRO.
4- Supporting and promoting the methods of improving and developing programs of health care of chronic noncommunicable diseases patients within the activities of PHC, as well as overcoming the shortage in the assistant health cadres in this field.
Resolution # 5 was issued by the Health Ministers in the 58th conference (Muscat, Muharram 1426 H – 2005) the resolution emphasized on:
a- Giving effect to the International Strategy on Diet, Physical Activity and Health, in the health programmes and departments related to the MOH, due to the contained approaches at international, regional and national levels.
b- Work towards implementation of the prevention programmes of prevention and control of communicable and non-communicable diseases within a comprehensive and integrated health system with primary health care that is based on the double confirmation.
Resolution # 2 (Conference 60 Manama, Bahrain, Muharram 1427 H / February 2006) decided the executive framework in terms of :
- Approval on holding a Gulf workshop in coordination and cooperation with the Eastern Mediterranean Regional Office, in Kuwait during the second half of 2006, with the objective of putting EMAN project into action, monitoring and analysis of the current situation, defining the difficulties and constraints in the member Council States, and putting a phased work plan with well defined objectives.
- Strengthening and support of applied research on health and economic burden of con-communicable diseases abased on adoption of the theme “promotion of Non-communicable diseases is an Important human and social investment).
The Gulf programme had been reviewed in the 65th meeting of the Executive Body (Riyadh, Dhul-Qada, 1427 H / November 2006) where recommendation # 5 was issued, and consequently raised to the Health Ministers in their 62nd conference in Kuwait (Muharam 1428 H/ January 2007) where it issued resolution # 3 – the resolution emphasized the following:
1- Endorsement of the recommendations of the Gulf workshop: EMAN project, and working towards putting it into action, and according to the available facilities, the member states, especially as follows:
a) Giving effect to the confrontation of non-communicable diseases at the level of the primary health care.
b) Development of information systems related to this group of diseases.
2- Approval to establish a “Gulf Committee” which involves officers involved in EMAN to follow up recommendation of Kuwait workshop, to be the basis for a main Gulf Committee for Control of non-communicable diseases aiming at integrating avoiding duplication of the many activities in this field, and coordination with related technical committees.
Due to the many Gulf programmes in the filed of control of noncommunicable diseases, being all under the umbrella of health promotion and healthy life style, the Executive Body, in its 66th meeting (Riyadh, Rabi I, 1428 H/ April 2007) issued recommendation # (30) which entailed holding a Gulf workshop with participation of representatives from the Council States technical committee members from PHC, Diabetes Control, CVDs control, health education / EMAN.
The objectives of the workshop were:
a- Health promotion and healthy life style.
b- Setting the “Strategic Framework to realize the objectives and targets through an executive work plan according to a specific timeline as well as putting the vision mission, objectives and targets.
c- Work towards integration and prevention of duplication of the many activities and programmes in the file of the non-communicable diseases.
d- Establishing the Gulf committee for control of non-communicable diseases.
The Health Ministers affirmed in their 63rd meeting (Geneva, Rabi II, 1428 H/ May 2007) these leading directions through resolution # 8 which approved the objectives of the workshop as detailed above.
The 67th meeting of the Executive Committee (held in Riyadh, Dhul Qada, 1428 H – November, 2007) discussed the subject in depth, and issued recommendation # 8 which involved:
I) Endorsing holding the workshop (Confronting the chronic non-communicable diseases risk factors, under the umbrella of health promotion and healthy life style) with :
1- Realizing the objectives of the workshop towards formulating the Gulf strategy for health promotion, including the general strategic framework to carry out the objectives and targets through an executive plan.
2- The scientific programme of the workshop should include:
Work towards preparing and developing mechanisms of effective coordination between various many technical committees for control of NCDs diseases, and in avoidance of duplication and realization of integration among these committees.
II- Giving effect to the International Strategy on Diet, Physical Activity and Health. This is done through :
defining the responsible body (department/division) in the ministries of health in the Cooperation Council States to undertake the implementation of this strategy, and coordination with the various related bodies at the national level.
(Current Situation in the Council States.)
Gulf workshop on EMAN
This was held in Kuwait (21-23 Jumada I, 1427 H- 17-20 June, 2006) It represented a leading model for constructive collaboration between the ministry of health in Kuwait and the Executive Board and EMRO. Many international, regional, and Gulf prestigious experts participated in this workshop.
The main purpose was to set the unified strategies for the Gulf countries for prevention of NCDs. Main objectives of the workshop were:
● Emphasis on building capacities for the staff in the fields of prevention and control as well as various curative modalities.
● Setting a system for epidemiologic control, surveillance and evaluation of risk factors related to NCDs, and monitoring its results using the STEPwise approach for planning and development of the appropriate programmes for its control based on and integrative health system.
The recommendations formed a basis for integrated Gulf programmes, they included:
● Review of the methods of combating NCDs at the level of PHC & setting the modern bases for building the capacities of the staff through support of family and community medicine.
● Encouraging and supporting community initiatives to face common risk factors for NCDs in cooperation with WHO.
● Starting the executive actions to deal with the health strategies with regard to nutrition and physical activity at the level of the Council States together with provision of technical support on the part of WHO in this respect.
The Gulf Regional Workshop
On “Giving Effect to the International Strategy for Diet, Physical Activity and Health”
This had been held in the UAE (Safar 1428 H/March 2007) under the patronage of HE Mr Humaid Al-Qutami, Minister of Health, UAE in cooperation with the WHO/HQ, WHO/EMRO and the Executive Board for the Health Ministers’ Council for the Cooperation Councel States.
The workshop came up with a number of noteworthy recommendations:
A) At the level of the Executive Board
- Including prevention of NCDs (cardiac diseases, diabetes, cancer) within the priorities of the Health Ministers’ Council agenda, with emphasis on the amenable risk factors such as unhealthy nutrition, physical in activity.
- Establishing a coordinating committee to undertake the responsibility of follow up of the implementation of the international strategy on diet, physical activity and health at the level of the Council States in the Gulf.
B) At the level of the member states
- Establishing a national coordinating committee for follow up of implementation of the strategy.
- Emphasis on the importance of the WHO STEPwise approach, concerned with the risk factors related to unhealthy diet and decreased physical activity.
- Building capacities to encourage physical activity.
- Amending rules and regulations so as to encourage healthy diet, physical activity and health.
C) At the level of the World Health Organization
- The WHO shall provide technical support related to the international strategy on diet, physical activity and health to support its implementation in the right way.
In the 64th conference held in Riyadh throughout the period (Muharram 1429 H / February 2008) the Health Ministers affirmed the importance of putting the criteria and standards of healthy diet as an entrance in the Control of NCDs programme, and resolution # (6-C) was issued which included the following:
1- The Council affirms the importance of the issue of healthy diet, physical activity in the prevention of NCDs and the serious role played by the unhealthy components and fast food industries in the increased rates of risk factors leading to such group of diseases which extended its effect to children and youngsters.
2- Urging the Council states to establish public health committees in coordination with concerned ministries; industry, commerce, agriculture and other concerned bodies such as standardization and specifications organization, municipalities, and food industries as well as consumer protection societies to work towards setting national strategic plans for healthy diet, guided with the international strategy for diet, physical activity and health (endorsed by the resolution # 5, conference 58) and endorsing the international standards of healthy diet.
3- Raising the issue to HE the Secretary General of the Cooperation Council for Arab Gulf countries:
a) Working towards updating and developing the Gulf standards and specifications of food industries (pre-fabricated and canned) to match the scientific updates and to be according to standards which aim at setting the healthy diet specifications by the Gulf standardization and specifications organization and to set comprehensive and integrated standards as well as a directed workplan to minimize risk factors related to diet and its ingredients.
b) Requesting the standardization organization not to issue any food specification except after its submission to and its endorsement by the concerned health authorities, and to work towards improving the public health of the Gulf citizens.
4- Intensifying constructive cooperation with related authorities especially ministries of information, education, industry, agriculture and endowment towards setting a national alliance for health education to confront these deleterious community phenomena.
Most prominent activities:
1- Recommendation # 6 issued by the 70th Executive body meeting (Riyadh, 7-8/5/1430 H – 2-3/5/2009), which involved:
● Holding a Gulf workshop on “Health Promotion and Healthy Lifestyle – tackling Non-communicable Diseases”, with participation of concerned Deputy Ministers.
● Assigning the concerned Gulf technical committees related to control of noncommunicable diseases to continuously update the Gulf Executive plans so as to match the 2008 – 2013 Executive plan for the WHO Global Strategy for Prevention and Control of Noncommunicable Diseases.
2- Gulf project for control of chronic diseases risk factors
This has been proposed by the Executive Board, and it included a brief account on importance of the project, defined fields of application and strategic objectives; it also set the mechanism of implementation and the expected outcome and monitoring progress using measurable indicators.
The project was raised to their excellencies the Ministers of Health in the Cooperation Council States based on a recommendation made by the Executive body, and as a priority of the health investment programs in the upcoming stage.
3- International Alliance for Chronic Diseases
Where the Council States were invited for networking and communication for collaboration with this important scientific research alliance which was announced on 23 Rajab, 1430 H – 15 July, 2009. Research agencies from various countries as well as international support agencies will be invited. WHO will participate as an observer to take part and facilitate support of the alliance to implement the Executive plan of the Global Strategy for Prevention and Control of Noncommunicable Diseases.
4- The Consultative Meeting on NCDs in West Asia
(Held in Doha, Qatar, 10-11 May, 2009). The Director General of the Executive Board gave a very comprehensive presentation which included the magnitude of the problem in the Gulf community compared to the regional and international problem and the approach taken by the Health Ministers’ Council in Tackling this important health problem.
The meeting came up with some recommendations, the most important of which are:
● Setting multidisciplinary national and regional workplans.
● The Economic and Social Summit as well as the UN General Assembly should look at integration of NCDs and injuries indictors within the Millennium Development Goals.
● The governmental agencies have to integrate the monitoring process as part of the MDGs national process.
● The UN has to set and distribute the appropriate tools to allow decisions-makers to evaluate impact of policies.
5- WHO Initiative to include NCD within the new MDGs (MDGs – plus)
This was supported by Kuwait, Oman, Bahrain and recommended to be adopted as referred to above, in addition to strengthening scientific communication with NCD net, and close cooperation with international organizations.
6- The 71st Executive Body Meeting (Riyadh, 18-20/12/1430 H – 5-7/2/2009)
It issued recommendation # 6 which affirmed the following:
● Urging the Council States, scientific and academic agencies to join and network with the International Alliance for Chronic Diseases: and to take part in research activities, as well as preparing guidelines for policies and best practices related to prevention and treatment of non infectious diseases.
● The necessity to adopt WHO initiative to include NCDs within the new MDGs, with monitoring and evaluation of its indicators to assess progress made to implement MDGs. Scientific communication with NCD net should be extended to exchange experiences, studies and utilization in program development.
● Giving effect to the recommendations and outcome of the West Asia Ministerial meeting (Doha, 15-16 Jamadi I. 1430 H – 10-11/5/2009) and adoption of its declaration in setting related multidisciplinary national and regional plans.
Also dialogue should be facilitated between the national partners for the sake of defining permanent resources to finance the NCD programs of prevention.
The First NCD net Global Forum
This was held in Geneva (24/2/2010) and attended by the Executive body member of Kuwait Dr. Yousef Al-Nasef – representing the Executive Board. A report about the forum had been circulated to the member states.
Support of UN resolution concerning control of NCDs
The Director General presented this issue to the Executive body members requesting a unified Gulf perspective supporting issuance of this UN General Assembly resolution in Sept. 2011 which is considered historical. Thanks to these efforts, the UN General Assembly issued resolution 64/ 265 (prevention and control of noncommunicable diseases) in the 86th session, 13 May, 2010. It contained the following:
- A high level UN General Assembly meeting will be convened in Sept. 2011 about prevention and control of NCDs with participation of heads of states and governments.
- Consultation are going to be made about expanding the high level UN meeting, which should be concluded before the end of 2010.
The 72nd Executive Body Meeting
(Riyadh, 13-14/5/1431 H – 27-28/4/2010) issued recommendation # 7 involving the following:
1. Urging the member states to adopt the draft resolution submitted by the Caribean Group on Control of Non-communicable Diseases, supported by most related international agencies, organizations and societies, in the UN General Assembly (Sept, 2010) through endorsed formal diplomatic channels.
2. The Executive Board shall adopt the initiative on establishment of a regional/ Gulf network for NCD in cooperation with the WHO Eastern Mediterranean Regional Office. Preparations are to be made for the first meeting for the proposed network, which will be hosted in one of the Council States.
3. Setting the Gulf work plan for prevention and tackling of NCDs in line with the Global Strategy work plan, agreed upon in the 61st meeting of the WHA, Geneva, May 2008.
4. Encouraging joint Gulf studies and research and update of the database in the Executive Board and the ministries of health (prevalence of risk factors, morbidity and mortality of these diseases, evidence-based tools to monitor implementation of the Global Strategy at the national and Gulf level).
5. Coordination with the General Secretariat of the Gulf Cooperation Council, ministries of exterior and planning in the Council States, to adopt the proposal of inclusion of prevention of NCDs and the related risk factors within the reports for monitoring and follow up of progress made in implementation of MDGs in the Council States. Special sessions should be made in the Gulf Summit meeting in this respect.
6. Call for holding an expanded meeting for the Gulf Committee for NCDs in Bahrain (last quarter of 2010), with participation of Executive Body members (The Executive Body will bear the cost), members of the Gulf committees for Diabetes, Heart, Cancer Health Education, and Tobacco Control (The countries will bear the cost) with the aim of:
a) Establishment of the Gulf Committee for NCDs.
b) Setting the vision, mission, goals and targets.
c) Setting the general framework of the Gulf plan for control of NCDs.
The 73rd Executive Body Meeting
(Riyadh, 28-30/12/1431 H – 4-6/12/2010). It issued recommendation # 3 which involved:
1- Thanks and appreciation to Dr. Mariam Al-Jalahma – Bahrain Executive Body member, and to Dr. Yousef Al-Nasef – Kuwait Executive Body member, for preparing the draft project of the Gulf plan for control of NCDs (2011 – 2020)
2- Work towards utilization of KSA perspectives as a basis for dialogue in the expanded meeting referred to above with aim of setting a strategy for control of risk factors and early detection of non-communicable diseases, and avoidance of duplication with other executive plans.
3- Emphasis on commitment on the part of the Council States to effectively and positively participate in the expanded meeting of the Gulf Committee for Control of NCDs.
Work teams/ groups are to be established, and each is under supervision of one of the Executive Body member, and membership form various related technical committees.
4- Intensifying technical, scientific, media and diplomatic efforts towards a unified Gulf presence which is supportive to prevention and control of NCDs – as a platform for community development and investment in the High Level UN Summit in Sept., 2011.
The Expanded meeting of the Gulf Committee for Control of NCDs (Manamah, 5-6/2/1432 H – 9-10/1/2011) recommendations were presented to the Health Ministers’ Council in the 70th conference held in Doha/ Qatar, 3 Feb 2011 which issued resolution # (4).
Developmental steps needed Currently
1- Establishment of a principal Gulf committee to undertake the process of followup of implementation of recommendations of the workshop on linkage with EMAN network. This committee will be a nucleus for the General Gulf Committee for Control of NCDs.
2- Support and promotion of optimal methods of development of health programs for such group of diseases and implementation within an integrated comprehensive health system within PHC - based on double tackling method.
3- Giving effect to the Global Strategy for Diet, Physical Activity and Health, through various health programs and departments and in collaboration with related governmental and non governmental agencies within a comprehensive systematic national framework.
4- Holding a Gulf/ regional conference on confrontation of the current challenge of control of NCDs with the aim of putting the Global Strategy on Diet, physical Activity and Health, into action.
5- Support of research and studies for estimation of economic burden consequent upon the chronic diseases and the related risk factors.
Unifying all related activities and programs in the field of control of non-infectious diseases within a unified national and Gulf framework under the umbrella of (health promotion and healthy Life Style) guided with successful experiences; such as:
1. Kingdom of Bahrain experiment concerning Health Promotion Council and its role in control of chronic diseases.
2. Kuwait program on “Health Promotion as a comprehensive umbrella to all programs of control of chronic diseases”.
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