Noncommunicable Diseases and Mental Health - WHO Western ...

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Noncommunicable Diseases and Mental Health - WHO Western ...

9. Noncommunicable Diseases and Mental HealthNoncommunicable Diseases. Tocombat the rapidly escalatingnoncommunicable disease (NCD) epidemicin the Western Pacific Region, WHO iscontinuing its focus on regional and nationalcapacity-building in surveillance, preventionand control. Surveys completed over the pastyear clearly show the rise in NCD.In the Philippines, the recentlypublished national nutrition survey foundthat overweight, as measured by the waisthipratio, had risen from 39.5% to 54.8% ofadult women between 1998 and 2003. Some22% of adults in the Philippines are nowclassified as hypertensive.Cambodia, a country previously thoughtto be mainly suffering from traditional causesof morbidity, now has a growing diabetesproblem. A November 2004 study reported adiabetes prevalence of 4.8% in Siem Reap and11.4% in Kampong Cham, levels comparableto those found in more advanced economiesof the Region. Cambodia, like other countriesin the Region, now faces a double burden ofdisease—increasing trends of bothnoncommunicable and communicablediseases.In the Pacific, eight countries and areas 1are in the process of finalizing their nationalsurveys as part of the WHO STEPwiseapproach to noncommunicable diseasesurveillance (STEPS). Most of these countriesare expected to publish results by the end of2005. Kiribati’s survey is in the field, andTonga is completing data entry. Tokelau,Tuvalu, Solomon Islands and Vanuatu aredeveloping survey plans. There is consensusamong the countries and areas involved thatcarrying out a STEPS survey contributesdirectly to the development of nationalstrategies as they gain a deeperunderstanding of NCD causative factors andare more motivated to develop preventiveactivities.Two meetings in the Region gaveparticipants an opportunity to exchangeexperiences in NCD prevention andcontrol, as well as discuss ways tostrengthen capacity in the use of theSTEPwise Planning Framework firstdeveloped in the context of the Tonga1American Samoa, Cook Islands, Fiji, Marshall Islands, theFederated States of Micronesia, Nauru, Palau and SamoaCommitment. An NCD networking meetingwas held in August 2004 in Manila. Most ofthe countries represented later attended aninternational visitors programme organizedby Japan’s National Institute of Public Healthin April 2005. That programme showcasedHealth Japan 21, a national health promotiontargeting “lifestyle-related diseases”, thecommon term for NCD in Japan. Participantsat the programme developed action plans inNCD intervention that are being pursuedthroughout 2005. These plans focus onnational NCD strategies, surveillance, healthpromotion and clinical management.Several countries made significantprogress in their response to NCD. Chinareceived a high-level delegation from WHOand set up a national task force which, withthe help of consultants, developed the firstdraft of a national NCD response. A national26THE WORK OF WHO IN THE WESTERN PACIFIC REGION


9. N O N C O M M U N I C A B L E D I S E A S E S A N D M E N T A L H E A L T Hmultisector consultation was held to refinethe strategy, and further consultation andreview are being organized to draw up anational plan for State Council consideration.Viet Nam has defined its nationalsurveillance system around the national NCDvision endorsed by the prime minister threeyears ago. This surveillance system is beingpiloted along with provincial interventionsset up in the last year for diabetes andcardiovascular diseases. National guidelineson diabetes management completed last yearhave been published, and training has beenorganized in two demonstration provinces.The Philippines Coalition completed itsinitial year of work in April 2005. It representsan excellent model of nongovernmental andgovernmental collaboration. It was foundedaround a vision defined by a common set ofperformance indicators. Work of the coalitionincluded a formal dialogue with fast foodproducers to attempt to influence theirresponse to the Global Diet and PhysicalActivity Strategy.Throughout the Region, resources haveremained tight despite the enormous NCDburden. Yet, there has been significant actiontaken over the past year for capacity-buildingat the national level. At the regional level,two networking and training meetings wereconducted during the year. Surveillanceactivities continue with the production ofimproved datasets on NCD risk factors in boththe Asian and Pacific portions of the WesternPacific Region.Mental Health andSubstance Abuse. The WHOprogramme in mental health and the controlof substance abuse works toward three goalslaid out in the Regional Strategy for MentalHealth: reduce the human, social andeconomic burden produced by mental (e.g.depression), neurological (e.g. epilepsy) andsubstance abuse (e.g. alcoholism) disorders;promote mental health; and give appropriateattention to the psychosocial aspects of healthcare.WHO is continuing its collaboration inthe development and implementation ofmental health policy and legislation with anumber of countries including China, Fiji,Mongolia, Samoa, Solomon Islands, Vanuatuand Viet Nam. With support from WHO,fellows from China, Mongolia, Samoa andViet Nam participated in the InternationalMental Health Leadership Programme, anopportunity to engage with the issues andpeople at the forefront of internationalmental health. In addition to the four-weektraining, the fellows will be supervisedthrough ongoing consultations with technicalexperts during and even beyond the one-yearprogramme.In order to assist countries and areas inthe Western Pacific Region in formulatingmental health policies and strategicimplementation plans, a programme oftechnical support for the organization ofmental health services is being developed.Support is being provided to assess mentalhealth needs and consult in theestablishment of a Mental Health Networkin the Pacific. The aims of the proposedNetwork are to assist countries in improvingtheir mental health services, policy andplanning; to reduce unnecessary duplicationand fragmentation of activities; to encouragemore cooperation and collaboration; to buildsustainability, capacity and capability; andto help achieve the health-relatedMillennium Development Goals.27THE WORK OF WHO IN THE WESTERN PACIFIC REGION


9. N O N C O M M U N I C A B L E D I S E A S E S A N D M E N T A L H E A L T HIntegrating mental health care intogeneral health services, particularly at theprimary level, is one of the most importantstrategic thrusts in improving mental healthservices. Continuous support has beenprovided on this front, including:• training workshops for primary healthworkers in China, Fiji, Mongolia, Papua NewGuinea and Viet Nam;• evaluation of the effectiveness ofprevious training activities on improvingmental health services in China, Fiji,Mongolia and Papua New Guinea;• a demonstration project oncommunity-based control of epilepsy inChina; and• a planned investigation of thetreatment gap in rural areas in two countries.Substance use disorders have become apublic health concern in some countries inthe Region. Problems related to alcohol useaccounted for 5.5% of the overall regionaldisease burden. Over the past year, WHOcosponsored two regional meetings to raiseawareness of the relation between substanceabuse and both physical and mentalhealth—the Asia Pacific Institute ofAddictions, held in Singapore, and theMeeting on Alcohol and Health in the Pacificheld in Noumea, New Caledonia. As astarting point for the development of a policyand a strategic plan, a survey on alcohol useand related harm will be conducted as part ofthe STEPS survey in Solomon Islands,Tokelau and Tuvalu. In Mongolia, WHO issupporting the national epidemiologicalsurvey on alcohol use and related harm. Thesocial and economic cost associated withalcohol use is being reviewed and evaluatedin China.In the Region, suicide was the leadingcause of injury death in 2000, surpassingdeaths from traffic accidents, falls and otherinjuries. Based on WHO estimates, the crudesuicide rate for the Region is 19.3 deaths per100 000 persons compared to a global estimateof 14 per 100 000. Suicide is among the top 10causes of death in some countries in theRegion. A number of countries areexperiencing increases in suicide.Preparations are under way for anAugust 2005 regional meeting on suicideprevention. The objectives of the meeting arethe presentation of updated suicidestatistics and a discussion of quality datamanagement; the sharing of knowledge andexperiences in the development,implementation, and evaluation of nationalsuicide prevention strategies; andidentification of priority actions required atcountry and regional levels.28THE WORK OF WHO IN THE WESTERN PACIFIC REGION

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