Strategies for NCD Risk Factors(cont...)

Harmonize Tobacco Taxes and Strengthen Anti-Smuggling Measures

Recognizing that smuggling can undermine FCTC implementation, in March, 2010, an FCTC working group (which includes South Asian countries) developed a draft protocol to control illicit tobacco trade (Intergovernmental Negotiating Body 2009).28 Areas the protocol covers are its relationship to other international agreements, such as the UN Convention against Transnational and Organized Crime, the development of an international tracking and tracing system, and requirements for wholesale customer identification and verification.

Strategies for NCD Risk Factors(cont...)

Figure 7.1 Share of total and excise taxes in the price of 20 piece pack of the most sold brand of cigarettes (top) and for the most sold brand of bidis (bottom), South Asia, 2008

Source: WHO 2008b

Introducing the Policy Options Framework(cont...)

Table 5.1 Policy options framework for prevention and control of NCDs

Source: Authors’ conclusions. The above is a guide to focus policy discussion and actions in key areas. The context of the setting will dictate final options and decisions.

The rationale and activities for each program management stage are as follows.

Access stage

At the Assess stage information is collected that will facilitate efficient and effective planning and preparation, and help strategically target actions and prevention and control efforts.

plan stage

The Plan stage entails analyzing information collected from assessments, engaging key stakeholders for prevention from inside and outside the health sector (e.g., transportation, agriculture, commerce, urban planners, and business leaders) for treatment in both public and private sectors.

NCD stakeholders extend from government and ministries of health to private sector providers, from individuals to communities, nongovernmental organizations (NGOs), health care providers, academia, and donor partners. Consensus and ownership are all needed for plans to be widely advocated, adopted, financed, and eventually institutionalized.

Develop and Implement stage

The Develop and Implement stage is where broad implementation of prevention policies and scaling up clinical interventions strain all health sectors and, potentially, non-health sectors. Developed-country experiences provide some grounding. However, major revamps, and in many cases innovation, will be needed to develop effective policies for both individual- and population-based health promotion in developing countries. Currently, in terms of clinical services, only a few care delivery models exist and their effectiveness remains unclear.

Health services delivery will need retooling, clinical quality assessment procedures require development and implementation, and drug policies need to assure quality, availability, and affordability of essential medications. Other major challenges in the Develop and Implement stage are human resources and financing population-based policies as well as clinical prevention and treatment services.

These measures can impose a substantial cost burden on governments. The importance of the Evaluate stage becomes clear when one understands that countries are currently spending substantial resources on NCDs, especially on individual-based treatment. As capacity rises,

programs launch, and investments grow, evaluating progress at all levels is essential to assure that goals are reached.

For NCDs, the track record is short, experience is limited, but some new initiatives have

already been launched or are being planned. Decision makers will greatly benefit from evaluating

progress and health systems performance as utilization patterns evolve in the future.

For some stages, such as Assess and Plan, the framework will produce country-level policy options and actions, as well as strategies, which will be similar for each country across the region.

However, Develop and Implement and Evaluate will tend to be more country-specific, depending on the burden and capacity. Some important elements may lie beyond the capacity of a country acting alone and are not feasible at the country level, such as efforts in comparative effectiveness assessments for new service delivery interventions. Big-country lifestyle messages and food and tobacco policies, such as those emanating from India, can have a large influence on small countries, also suggesting regional approaches for some elements. Chapter 7 explores when regional strategies may be a feasible alternative.

Introducing the Policy Options Framework(cont...)

In each of the four program management stages, action areas that play an important role in both modes of intervention for prevention and control of NCDs are identified (Table 5.1). The population-based interventions are divided into policy options that lie within the control of the non-health and health sector.

Similarly, the individual-based interventions are

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Introducing the Policy Options Framework

From a policy perspective, this framework is useful because population-based and individual-based interventions mobilize different parts of the non-health and health sectors and require very different inputs in terms of infrastructure, capacity, and skill sets; they also yield very different outputs and outcomes.

Harmonizing both intervention modes is necessary to ensure the right mix and that

population-based interventions complement those delivered within the clinical care system.

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Part B - Main Examination - Optional Subjects Paper-I One of the Indian Languages to be selected by the candidate from the 22 languages included in the VIIIth Schedule to the Constitution (Qualifying Paper) 300 Marks Paper-II English (Qualifying Paper) 300 Marks Paper-III Essay [in the medium you choose] 200 Marks Papers IV & V General Studies (300 Marks for each paper) 600 Marks Papers VI, VII, VIII & IX Any two subjects (each having 2 papers) to be selected from the prescribed optional subjects (300 marks for each paper) 1200 Marks Total Marks for Written Examination 2000 Marks Interview Test [in the medium you choose] 300 Marks Grand Total 2300 Marks

Introducing the Policy Options Framework

Introducing the Policy Options Framework

While the health sector bears most of the burden in the prevention and treatment of NCDs, many of the interventions to control NCDs lie outside the health sector. This book introduces a policy options framework that applies to any country.

Developing a Policy Options Framework for Prevention and Control of NCDs

Key messages

* The policy options framework helps countries to develop or improve their programs for

prevention and treatment of NCDs. It has four stages: Assess, Plan, Develop and Implement, and Evaluate.

* In repurposing the framework to their own context, health policy makers will need to consider

their disease burden, health capacity, and other country-specific factors in order to determine

how much to focus on preventing disease versus treatment of those already affected.

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Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs

Combined Population- and Individual-based Interventions

World Bank (2006) recommends a set of combined population- and individual-based interventions to tackle part of the CVD burden in low- and middle-income countries (Appendix 3, Tables A3.2 and A3.3):

* Management of acute myocardial infarction with aspirin and beta-blockers

* Primary prevention of coronary artery disease with legislation substituting 2 percent of trans fat with polyunsaturated fat

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCD(cont...)

Individual-based Interventions

There is fairly strong effectiveness evidence from randomized control trials supporting the use a number of drugs to prevent (or manage) CVD by reducing blood pressure or blood cholesterol (Jackson et al. 2005). This evidence has been used by Lim et al. (2007) to model the cost-effectiveness of pharmacological interventions among high-risk individuals in the same set of 23 low- and middle-income countries as Asaria et al. (2007).

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs(cont...)

As briefly noted in Chapter 3, some encouraging effectiveness evidence for population-based interventions to lower saturated fat intake have come from two countries.

1) intervention, a government-led program in Mauritius (Hodge et al. 1996) changed the main cooking oil from a predominantly saturated-fat palm oil to a soybean oil high in unsaturated fatty acids. As a result, total cholesterol concentrations fell by 14 percent during the 5-year study period from 1987 to 1992. Changes in other risk factors were mixed, with reductions in blood pressure and smoking rates, yet increases in obesity and diabetes.

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs(cont...)

If the tobacco and the salt interventions are implemented jointly, the authors estimate that over the entire 23 countries, 13.8 million deaths could be averted, at a cost of less than US$0.40 per person a year in low-income and lower middle-income countries, and US$0.50–1.00 per person a year in upper middle-income countries (as of 2005).

English - 1997 (Main) (Compulsory)-UPSC EXAM MATERIALS

English - 1997 (Main) (Compulsory)

Time Allowed : Three Hours Maximum Marks : 300
INSTRUCTIONS
Candidates should attempt all questions.
The number of marks carried by each question is indicated at the end of the question.
Answers must be written in English.
Q. 1. Write an essay of about 300 words on any one of the following : 100
(a) Tolerance is the key to national unity
(b) Your idea of a happy life
(c) Advertisements : need for control
(d) Is vegetarianism a virtue ?
(e) Failures are the pillars of success
Q. 2. Read the following passage carefully and answer the questions that follow in your own words as far as possible. 75
It is true that the smokers cause some nuisance to the non-smokers, but this nuisance is physical while the nuisance that the non-smokers cause the smokers is spiritual. There are, of course, a lot of non-smokers who don't try to interfere with the smokers. It is sometimes assumed that the non-smokers are morally superior, not realizing that they have missed one of the greatest pleasures of mankind. I am willing to allow that smoking is a moral weakness, but on the other hand we must beware of a man without weakness. He is not to be trusted. He is apt to be always sober and he cannot make a single mistake. His habits are too regular, his existence too mechanical and his head always maintains its supremacy over his heart. Much as I like reasonable persons, I hate completely rational beings. For that reason, I am always scared and ill at ease when I enter a house in which there are no ash-trays.

UPSC EXAM PAPERS FOR ENGLISH ESSAY

ESSAY - 1977
Q. Write essays on any two of the following topics:
1. “More than the means of production science transforms the producer himself”.
2. Indian science should be rooted to the Indian soil.
3. Is ecology relevant to India?
4. Education as an avenue of social mobility.
5. Modernization as a contemporary myth.
6. Is consumer protection possible in India?
7. The concept of a welfare state.
8. Role and responsibilities of the judiciary in a Parliamentary democracy.
9. Democracy and the leadership principle.
10. India’s composite culture.

GENERAL ENGLISH - 1977
1. Make a précis of the following passage in about 340 words. The précis should be in your own words.

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs(cont...)

Population-based Interventions

In terms of population-based interventions specifically, few public health experts would question the benefits of evidence-based tobacco control measures, as contained in WHO’s Framework Convention on Tobacco Control (FCTC). Asaria et al. (2007) model the effects of a key set of tobacco measures contained in the FCTC (increases in the price of tobacco, enforcement of smoke-free workplaces, packaging and labeling changes, public awareness campaigns, and a

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs(CONT...)

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs

The majority of studies discussed below looked at one single intervention at a time, comparing it to an alternative of no intervention. Murray et al. (2003) have made an effort to evaluate different combinations of various levels of interventions, primarily through a modeling approach. They examined 17 population-based and individual-based health service interventions or combinations of the two, for 14 WHO subregions (including SEAR-D and SEAR-B).

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs

Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCDs

Policy makers and others use cost-effectiveness studies (among others) to help decide on interventions to improve public health. Cost-effectiveness analysis (CEA) compares the costs of the intervention to the resulting change in health.14

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Prevention vs. Treatment(cont...)

During the last few decades, knowledge of pathophysiology, of risk factors and their role in causing disease, and of the impact of reducing risk factors on developing disease, has increased dramatically. In addition, many effective treatments to lower the risk of complications have been developed. Several studies have examined these secular trends to determine the factors accounting for these declines (see the sources at Table 4.1 for a nonexhaustive listing).

Prevention vs. Treatment

Defining the Focus of NCD Interventions: Prevention vs. Treatment

Figure 4.1 Heart disease death rates among men aged 30 years and older in Australia, Canada, United Kingdom,and United states,1950-2002

Source: WHO 2005.

Prevention of NCDs

Prevention of NCDs

The commonly used construct for combating NCDs—primary, secondary, and tertiary prevention (Box 4.2)—is useful, especially for health workers considering the range of interventions within populations for which they provide care. It also conforms to the different levels of health services, which are relevant to health care providers and policy makers.

Opportunities for Prevention and Control(cont...)

For each country, the focus and prioritization of efforts depend on the disease burden, health and nonhealth sector capacity, government priorities and resources, and the policy environment. Policy makers need to consider the role of the public sector in the following (and see Chapters 6 and 7):

* Population-based NCD burden assessments and surveillance to monitor change and improve

policy decisions

* Strategy development and coordination within and outside the health sector

Opportunities for Prevention and Control(cont...)

What Can Governments Do?

Moving to the role of governments, the World Bank Human Development Network document, Public Policy and the Challenge of Chronic Noncommunicable Diseases (Adeyi et al. 2007) had two key messages.

First, public policies are needed to prevent NCDs, to promote healthy aging, and to avoid premature death.

Strategies for NCD Risk Factors(cont..)

Table 7.1 Tobacco prevention and control policies in South Asia

Source: WHO 2008b.

Strategies for NCD Risk Factors

Expand and Harmonize Tobacco Advertising Bans to Reduce Demand

Tobacco is a major NCD risk factor common to the region. Most countries’ tobacco policies have advertising bans for national TV, radio, magazines, and newspapers, although most of these bans do not extend to international media (Table 7.1). Only half have policies for warning labels on tobacco packaging.

Guiding Principles for Regional Collaboration(cont...)

Guiding principles developed by the World Bank (Development Committee 2007) established the following criteria where global collaboration should be considered:

(i) there should be an emergent consensus in the international community that global action is required;

(ii) there should be an institutional gap that international agencies could help fill to encourage global action;

(iii) international agencies should have the requisite capabilities and resources to be effective;

Guiding Principles for Regional Collaboration

Guiding Principles for Regional Collaboration

Policy makers use the concept of public goods to define the role of government and international agencies in policy implementation. But as globalization gathers pace, goods—as well as diseases— cannot be kept within national borders. Experiences inside and outside public health can provide guidance on where collaboration may have advantages.

Regional Strategies for NCD Prevention and Control(cont...)

INTRODUCTION(cont...)

Several other situations may benefit from international collaboration. For example, smaller countries may not—alone—be able to carry out important activities efficiently, including training health professionals; purchasing, manufacturing, and regulating drugs; and conducting research.

Regional Strategies for NCD Prevention and Control

Introduction

The NCD burden, using any of the comparable measures available, is highly variable across south Asia (as noted in Chapter 1). However, by contrast, NCD risk factors are similar, especially for tobacco—which has the best data, and to a more limited degree with available data, for diet and alcohol use.

Regional Strategies for NCD Prevention and Control

Key messages

* Regional strategies could enhance NCD prevention, especially for tobacco and food.

* Three main situations lend themselves to regional cooperation: when there are positive or

negative externalities, there are economies of scale and scope, and the production (or prevention) of a good is only possible if all countries participate.

Country Capacity and Accomplishments and Application of the Policy Options Framework(cont...)

Sri Lanka

Key Policy Options and Strategic Actions

Assess

* Develop a NCD surveillance system. A national ongoing NCD surveillance system is required for strategic planning. It should include behavioral risk factors, NCD morbidity, mortality, health

services utilization, and special population-based registries for cancer and injury.

Country Capacity and Accomplishments and Application of the Policy Options Framework(cont...)

Pakistan

Key Policy Options and Strategic Actions

Assess

* Create a national NCD surveillance system. Needed to inform strategic planning and policy, this will allow implementation of the national NCD policy to have more immediate impact. Initial

efforts can be built on. In 2003, a pilot was implemented in one district (population 1 million) for

developing a model for population based surveillance of NCDs.22 Results of the initial round of