2014 Country Proﬁles Noncommunicable Diseases

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Noncommunicable Diseases

Country Profiles 2014

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Noncommunicable Diseases

Country Profiles 2014

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1.Chronic Disease - epidemiology. 2.Chronic Disease - prevention and control. 3.Chronic Disease - mortality. 4.National Health Programs. 5.Program Evaluation. I.World Health Organization.

ISBN 978 92 4 150750 9 (NLM classification: WT 500)

© World Health Organization 2014

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Acknowledgements Foreword

Explanatory notes

- Background - Demographics - Mortality

- Adult Risk Factors

- National Systems Response to NCDs - References

Country profiles

6 7 9

9

10

11

13

14

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Acknowledgements

This report was prepared by Leanne Riley and Melanie Cowan.

Contributions to the report were made by Abidkamal Alisalad, Timothy Armstrong, Misha Bajwa, Colin Bell, Douglas Bettcher, Alison Commar, Jean-Maire Dangou, Majid Ezzati, Ibtihal Fadhil, Alexandra Fleischmann, Heba Fouad, Gauden Galea, Renu Garg, Regina Guthold, Samer Jabbour, Branka Legetic, Colin Mathers, Hai-Rim Shin, Gretchen Stevens, Anita Stransdsbjerg, Edouard Tursan d’Espaignet, Menno Van Hilten, Cherian Varghese, and Alexandria Williams.

Sincere thanks to all Member States for their assistance with the assessment of the national systems response

component of this report.

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Foreword

Current global mortality from noncommunicable diseases (NCDs) remains unacceptably high and is increasing. Thirty-eight million people die each year from NCDs, mainly from cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Over 14 million deaths from NCDs occur between the ages of 30 and 70, of which 85% are in developing countries. These premature deaths are largely preventable by governments implementing simple measures which reduce risk factors for NCDs and enable health systems to respond.

In September 2011, world leaders adopted the Political Declaration on NCDs at the United Nations General Assembly in New York and committed to develop national multisectoral plans to prevent and control NCDs, and to consider the development of national targets to focus efforts and assess progress made. At the same time, the 2011 Declaration gave WHO a leadership role, together with several time- bound assignments.

These assignments, which have been completed, established a global infrastructure and a roadmap based on nine concrete global targets for 2025, organized around the WHO Global NCD Action Plan 2013- 2020. The Global Action Plan comprises a set of actions which, when performed collectively by Member States, international partners and WHO, will help to attain a global target of a 25% reduction in premature mortality from NCDs by 2025 and achieve the commitments made by world leaders in September 2011.

WHO’s Programme Budget 2014-2015 includes a dedicated budget line to provide technical assistance to countries in their efforts to set national targets for NCDs, develop national action plans, and monitor results.

The UN Interagency Task Force on NCDs, which the UN Secretary-General established in July 2013 and placed under the leadership of WHO, has started to provide support to countries in mobilizing sectors beyond health to address NCDs. The WHO Global Coordination Mechanism on NCDs, established in May 2014, will facilitate engagement among Member States and non-State actors. The global infrastructure will accelerate national efforts to address NCDs.

Progress within countries matters most. Some striking achievements emerge from a survey conducted by WHO last year. Of the 178 countries reporting data, 95% have a unit or department in the Ministry of Health responsible for NCDs. Half now have an integrated operational plan with a dedicated budget. The number of countries conducting recent surveys of risk factors jumped from 30% in 2011 to 63% last year.

In other words, more and more countries are getting the basics in place.

To provide the foundation for further advocacy, policy development and action, this report provides an overview of the current status of NCDs in each WHO Member State. The report assesses each Member State’s unique situation in face of the growing threat posed by NCDs.

It includes for each country, where available, estimates on the current burden and recent trends in NCD

mortality, prevalence of selected major risk factors, and the national systems capacity to respond to the

NCD challenge of epidemic proportions. Data in this report are drawn from multiple sources including data

provided by countries, estimates developed by WHO and the results of the global survey on assessment of

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national capacity for the prevention and control of NCDs which was conducted in 2013. Every effort has been made to incorporate the most comprehensive, recent and reliable data and to validate these data with countries and other sources. However, where data were scarce there is greater uncertainty around these estimates.

The report illustrates that, while many countries have started to align their policies and resources with the nine global targets and the WHO Global NCD Action Plan 2013-2020, progress in countries has been insufficient and highly uneven. Bolder measures are urgent to accelerate efforts to address NCDs and mitigate their impacts. I hope that the information contained in this second edition of the WHO NCD Country Profiles will be useful to governments and non-State actors in identifying areas for priority action.

WHO is launching this report on the occasion of the high-level meeting of the United Nations General Assembly to undertake the comprehensive review and assessment of the progress achieved in the prevention and control of NCDs (New York, 10-11 July 2014). The meeting will provide a timely opportunity for rallying political support for bolder measures. WHO, as a global beacon of solidarity, will continue to build a future that ensures that globalization becomes a positive force for all the world’s peoples of present and future generations.

Dr Oleg Chestnov

Assistant Director-General

World Health Organization

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Explanatory Notes

BACKGROUND

In September 2011 the World Health Organization released the first set of Noncommunicable Diseases Country Profiles, highlighting the status of NCDs in each WHO Member State. This second set of profiles builds on this earlier report and provides an updated overview of the NCD situation for each country. The focus in these new profiles is on presenting information for each country related to their NCD mortality, risk factors and national systems capacity to prevent and control NCDs. The profiles include the number, rates and causes of deaths from NCDs and trends in NCD mortality since 2000; the prevalence of selected risk factors; and information describing current national responses to prevention and control of NCDs. The data presented in each of the profiles are derived from several sources, each of which is explained in the following notes.

DEMOGRAPHICS

The 2012 population estimates from the most recent United Nations Population Division World Population Prospects (1) are reported in each profile for both total population as well as the population proportion between ages 30 and 70 years. World Bank income group data are based on 2012 gross national income (GNI) per capita, calculated using the World Bank Atlas method (2). The 2011 percentage of population living in urban areas was taken from the UN World Urbanization Prospects: The 2011 Revision (3).

MORTALITY

Age- and sex-specific all-cause mortality rates were estimated for 2000-2012 from revised life tables, published in World Health Statistics 2014 (4). Total number of deaths by age and sex were estimated for each country by applying these death rates to the estimated resident populations prepared by the United Nations Population Division in its 2012 revision (1).

Causes of death were estimated for 2000-2012 using data sources and methods that were specific for

each cause of death (5). Vital registration systems which record deaths with sufficient completeness and

quality of cause of death information were used as the preferred data source. Mortality by cause was

estimated for all Member States with a population greater than 250,000. Those countries with an asterisk

(*) on their profile have mortality data which are not based on any national NCD mortality data. These

NCD mortality estimates are based on a combination of country life tables, cause of death models, regional

cause of death patterns, and WHO and UNAIDS programme estimates for some major causes of death

(not including NCDs). Detailed information on methods for mortality and causes of death estimates were

published previously (5).

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Age-standardized death rates for cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes were calculated using the WHO standard population (5, 6). Proportional mortality (% of total deaths, all ages, and of both sexes) for communicable, maternal, perinatal and nutritional conditions;

injuries; cardiovascular disease; cancer; chronic respiratory disease; diabetes; and other NCDs is reported for 2012 (5).

The 2012 probability of dying between ages 30 and 70 years from the four main NCDs was estimated using age-specific death rates (in 5-year age groups, e.g. 30-34… 65-69, for those between 30 and 70) of the combined four main NCD categories, for each Member State (5). Using the life table method, the risk of death between the exact ages of 30 and 70, from any of the four causes and in the absence of other causes of death, was calculated using the equation below. The ICD codes used are: Cardiovascular disease: I00-I99, Cancer: C00-C97, Diabetes: E10-E14, and Chronic respiratory disease: J30-J98.

Five-year death rates were then translated into the probability of death for each NCD using the following formula:

The unconditional probability of death, for the 30-70 age range, was calculated last:

ADULT RISK FACTORS

Definition of indicators

Prevalence estimates are given for the following behavioural and metabolic risk factors:

• Current tobacco smoking (2011): the percentage of the population aged 15 or older who smoke any tobacco products.

• Total alcohol per capita consumption, in litres of pure alcohol (2010): consumption of pure alcohol (recorded and unrecorded) per person aged 15+ during one calendar year.

5

^*

M

_x

= Total deaths from four NCD causes between exact age (x) and exact age (x+5)

Total population between exact age (x) and exact age (x+5)

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• Raised blood pressure (2008): the percentage of the population aged 25 or older having systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg.

• Obesity (2008): the percentage of the population aged 20 or older having a body mass index (BMI)

≥30 kg/m2.

Methods of estimation

Crude adjusted estimates for raised blood pressure and obesity for 2008 are based on aggregated data provided by countries to WHO or obtained through a review of published and unpublished literature. The inclusion criteria for estimation analysis stipulated that data had to come from a random sample of the general population, with clearly indicated survey methods and risk factor definition. Detailed estimation methods have been published previously (7, 8).

Age-standardized prevalence for current tobacco smoking were estimated from national surveys that met the following criteria: provides national summary data for one or more of four tobacco use definitions- daily tobacco smoker, current tobacco smoker, daily cigarette smoker, or current cigarette smoker; includes randomly selected participants who were representative of the national population; and presents prevalence rates by age and sex. Countries with no surveys, or insufficient surveys (e.g. only one survey in total, or no survey during the previous 10 years), were excluded from the analysis. Regression models were run at the UN sub-region level to obtain age-and-sex-specific prevalence rates for current tobacco smoking for the year 2011. The estimated rates were then age-standardised to calculate average rates by sex for each country (9).

The primary data source for the estimates for total alcohol per capita consumption (APC) was official data on recorded alcohol per capita consumption supplied by the respective Member States. If these data were not available, data from economic operators and the Food and Agriculture Organization of the United Nations (FAO) statistical database (FAOSTAT) were used. The recorded three-year average APC for 2008–2010 and the unrecorded consumption for 2010 were added to arrive at the total consumption in litres of pure alcohol. For male and female per capita consumption, the proportion of alcohol consumed by men versus women plus the UN Population Division population estimates for 2010 (1) were used. Further detail on the estimation methods have been published previously (10).

NATIONAL SYSTEMS RESPONSE TO NCDS

All data in this section of the profile were taken from Member State responses to the 2013 NCD Country Capacity Survey (CCS). The 2013 CCS questionnaire was sent in electronic (Excel) format to the NCD focal points or designated colleagues within the Ministry of Health (MOH) or a national institute or agency in all WHO Member States (194 countries). The questions were developed in a manner intended to obtain objective information about adequacy of capacity and were reviewed in relation to the development of the objectives of the second Global NCD Action Plan. The 16 countries that did not respond to the survey have

“ND” (No Data) for all CCS related fields in this section of the profile.

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Responses related to the NCD surveillance and monitoring systems were checked against three separate

sources. The information on mortality was checked against data on vital registration systems held within

WHO in the Department of Health Statistics and Informatics. The responses on cancer registries were

checked against information held at the International Agency for Research on Cancer (IARC). Information on

recent NCD risk factor surveys were checked against internal survey tracking systems for WHO-supported

risk factor surveys, including WHO STEPS (adult risk factor surveillance), the Global School-based Student

Health Survey (GSHS), and the Global Youth Tobacco Survey (GYTS) held in WHO’s Prevention of

Noncommunicable Diseases Department. Where discrepancies were noted between the country response

and these other sources, a clarification request was returned to the country for their consideration and an

updating of their response.

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REFERENCES

1. World Population Prospects - 2012 revision. New York, United Nations Population Division, 2013.

2. World Development Indicators. Washington, DC, International Bank for Reconstruction and Development/

The World Bank, 2014.

3. World Urbanization Prospects: The 2011 Revision, CD-ROM Edition. New York, United Nations Population Division, 2012.

4. World Health Statistics 2014. Geneva, World Health Organization, 2014.

5. WHO methods and data sources for country-level causes of death 2000-2012. Geneva, World Health Organization, 2014.

6. Ahmad OB et al. Age Standardization of Rates: A New WHO Standard (Technical Report). GPE Discussion Paper Series: No.31. Geneva, World Health Organization, 2001.

7. Finucane MM et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. The Lancet, 2011, 377:557-67.

8. Danaei G et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. The Lancet, 2011, 377:568-77.

9. WHO report on the global tobacco epidemic, 2013. Geneva, World Health Organization, 2013.

10. Global status report on alcohol and health 2014. Geneva, World Health Organization, 2014.

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Afghanistan

Percentage of population living in urban areas: 23.5%

Income Group: Low Population proportion between ages 30 and 70 years: 24.4%

Premature mortality due to NCDs*

31% .

Adult risk factors

males total

Current tobacco smoking (2011) . . . .

Total alcohol per capita consumption, in litres of pure alcohol (2010) 1.2 0.7

Raised blood pressure (2008) 22.8% 22.5%

Obesity (2008) 1.4% 2.2%

National systems response to NCDs

Has an operational NCD unit/branch or department within the Ministry of Health, or equivalent No No

Has an operational policy, strategy or action plan to reduce the harmful use of alcohol No

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity No No Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets No Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

Has a national, population-based cancer registry No

* The mortality estimates for this country have a high degree of uncertainty because they are not based on any national NCD mortality data (see Explanatory Notes).

… = no data available

3.0%

Total population: 29 825 000

Has an operational multisectoral national policy, strategy or action plan that integrates several NCDs and shared risk factors

Has an operational policy, strategy or action plan to reduce the burden of tobacco use

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females . . . 0.1 22.1%

Total deaths: 250,000

NCDs are estimated to account for 37% of total deaths.

0 100 200 300 400 500 600

2000 2002 2004 2006 2008 2010 2012

age-standardized death rate per 100,000

0 5 10 15 20 25 30 35

2000 2002 2004 2006 2008 2010 2012

Number of deaths (thousands)

Number of deaths, under 70 years Males

0 5 10 15 20 25 30 35

2000 2002 2004 2006 2008 2010 2012

Number of deaths, under 70 years Females

Cardiovascular Diseases Chronic Respiratory Diseases

Cancers Diabetes

Cancers Diabetes Other NCDs

Cardiovascular diseases

19%

Cancers 6%

Chronic respiratory diseases

3%

Diabetes 1%

Other NCDs Communicable, 8%

maternal, perinatal and nutritional

conditions 46%

Injuries 17%

males females

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Albania

Percentage of population living in urban areas: 53.4%

Income Group: pper middle Population proportion between ages 30 and 70 years: 4 .2%

Premature mortality due to NCDs*

19% .

Adult risk factors

males total

Current tobacco smoking (2011) 48% 26%

Obesity (2008) 21.8% 21.3%

National systems response to NCDs

Has an operational NCD unit/branch or department within the Ministry of Health, or equivalent es No

Has an operational policy, strategy or action plan to reduce the harmful use of alcohol es

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity No No Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets No Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach es Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

20.8%

Total population: 3 1 2 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 5%

3.4 32.9%

Total deaths: 30,000

NCDs are estimated to account for 89% of total deaths.

0 100 200 300 400 500 600 700

2000 2002 2004 2006 2008 2010 2012

0 1,000 2,000 3,000 4,000 5,000 6,000

2000 2002 2004 2006 2008 2010 2012

Number of deaths

0 1,000 2,000 3,000 4,000 5,000 6,000

2000 2002 2004 2006 2008 2010 2012

59%

Cancers 16%

5%

Diabetes 1%

Other NCDs 9%

Communicable, maternal, perinatal

and nutritional conditions

5%

Injuries males 5%

females

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Algeria

Percentage of population living in urban areas: 73.0%

Income Group: pper middle Population proportion between ages 30 and 70 years: 40.0%

Premature mortality due to NCDs*

22% .

Adult risk factors

males total

Obesity (2008) 9.6% 16.0%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity es es Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

22.4%

Total population: 38 482 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 2%

0.4 28.7%

Total deaths: 219,000

NCDs are estimated to account for 77% of total deaths.

0 50 100 150 200 250 300 350 400 450 500

2000 2002 2004 2006 2008 2010 2012

0 5 10 15 20 25 30 35 40 45 50

2000 2002 2004 2006 2008 2010 2012

0 5 10 15 20 25 30 35 40 45 50

2000 2002 2004 2006 2008 2010 2012

41%

Cancers 10%

3%

Diabetes 7%

Other NCDs 16%

15%

Injuries males 8%

females

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Andorra

Percentage of population living in urban areas: 87.3%

Income Group: High Population proportion between ages 30 and 70 years: 55.7%

Premature mortality due to NCDs*

Adult risk factors

males total

Obesity (2008) 26.7% 25.2%

National systems response to NCDs

* ee Explanatory Notes

23.9%

Total population: 78 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

females . . . 8.2 21.9%

Total deaths: 50

Number of deaths, under 70 years

Males Number of deaths, under 70 years

Females Cardiovascular Diseases

Chronic Respiratory Diseases

2000 2002 2004 2006 2008 2010 2012

No Data vailable

2000 2002 2004 2006 2008 2010 2012

No Data vailable

2000 2002 2004 2006 2008 2010 2012

No Data vailable No Data vailable

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Angola

Percentage of population living in urban areas: 59.2%

Income Group: pper middle Population proportion between ages 30 and 70 years: 24.4%

Premature mortality due to NCDs*

24% .

Adult risk factors

males total

Obesity (2008) 3.5% 6.4%

National systems response to NCDs

Has an operational NCD unit/branch or department within the Ministry of Health, or equivalent ND ND

Has an operational policy, strategy or action plan to reduce the harmful use of alcohol ND

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity ND ND Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets ND Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach ND Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets ND

Has a national, population-based cancer registry ND

* The mortality estimates for this country have a high degree of uncertainty because they are not based ND = Country did not respond to country capacity survey on any national NCD mortality data (see Explanatory Notes).

9.1%

Total population: 20 821 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females . . . 3.0 27.4%

Total deaths: 301,000

NCDs are estimated to account for 24% of total deaths.

0 50 100 150 200 250 300 350 400 450

2000 2002 2004 2006 2008 2010 2012

0 5 10 15 20 25 30

2000 2002 2004 2006 2008 2010 2012

0 5 10 15 20 25 30

2000 2002 2004 2006 2008 2010 2012

9% Cancers 2%

2%

Diabetes 1%

Other NCDs 10%

66%

Injuries males 10%

females

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Antigua and arbuda

Percentage of population living in urban areas: 29.8%

Income Group: High Population proportion between ages 30 and 70 years: 43.1%

Premature mortality due to NCDs*

Adult risk factors

males total

Obesity (2008) 17.9% 25.6%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity No No Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets No Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach D Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

* ee Explanatory Notes

… = no data available D = Country responded don t know

33.0%

Total population: 89 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

females . . . 3.1 27.9%

Total deaths: 10

Number of deaths, under 70 years

Males Number of deaths, under 70 years

Females Cardiovascular Diseases

Chronic Respiratory Diseases

2000 2002 2004 2006 2008 2010 2012

No Data vailable

2000 2002 2004 2006 2008 2010 2012

No Data vailable

2000 2002 2004 2006 2008 2010 2012

No Data vailable No Data vailable

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Argentina

Percentage of population living in urban areas: 92.5%

Income Group: pper middle Population proportion between ages 30 and 70 years: 43.9%

Premature mortality due to NCDs*

17% .

Adult risk factors

males total

Obesity (2008) 27.1% 29.7%

National systems response to NCDs

Has an operational NCD unit/branch or department within the Ministry of Health, or equivalent es

No

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity es es Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets es

Has a national, population-based cancer registry es

32.0%

Total population: 41 087 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 16%

5.2 19.7%

Total deaths: 314,000

NCDs are estimated to account for 81% of total deaths.

0 50 100 150 200 250 300 350

2000 2002 2004 2006 2008 2010 2012

0 10 20 30 40 50 60

2000 2002 2004 2006 2008 2010 2012

0 10 20 30 40 50 60

2000 2002 2004 2006 2008 2010 2012

35%

Cancers 21%

7%

Diabetes 3%

Other NCDs 16%

11%

Injuries males 7%

females

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Armenia

Percentage of population living in urban areas: 4.1%

Income Group: Lower middle Population proportion between ages 30 and 70 years: 45.3%

Premature mortality due to NCDs*

30% .

Adult risk factors

males total

Obesity (2008) 14.3% 24.0%

National systems response to NCDs

Has an operational NCD unit/branch or department within the Ministry of Health, or equivalent es

No

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity es es Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach es Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets es

31.7%

Total population: 2 9 9 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 2%

2.6 40.7%

Total deaths: 37,000

NCDs are estimated to account for 92% of total deaths.

0 100 200 300 400 500 600 700 800

2000 2002 2004 2006 2008 2010 2012

0 1 2 3 4 5 6 7 8

2000 2002 2004 2006 2008 2010 2012

0 1 2 3 4 5 6 7 8

2000 2002 2004 2006 2008 2010 2012

54%

Cancers 22%

5%

Diabetes 3%

Other NCDs 8%

4%

Injuries males 4%

females

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Australia

Percentage of population living in urban areas: 89.2%

Income Group: High Population proportion between ages 30 and 70 years: 50.2%

Premature mortality due to NCDs

9% .

Adult risk factors

males total

Obesity (2008) 26.4% 26.8%

National systems response to NCDs

Has an operational NCD unit/branch or department within the Ministry of Health, or equivalent es es

27.1%

Total population: 23 050 000

Proportional mortality (% of total deaths, all ages, both sexes) Age-standardized death rates

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 19%

7.2 17.5%

Total deaths: 147,000

NCDs are estimated to account for 91% of total deaths.

0 50 100 150 200 250

2000 2002 2004 2006 2008 2010 2012

0 5 10 15 20 25

2000 2002 2004 2006 2008 2010 2012

0 5 10 15 20 25

2000 2002 2004 2006 2008 2010 2012

31%

Cancers 29%

7%

Diabetes 3%

Other NCDs 21%

3%

Injuries males 6%

females

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Austria

Percentage of population living in urban areas: 7.7%

Income Group: High Population proportion between ages 30 and 70 years: 54.0%

Premature mortality due to NCDs

12% .

Adult risk factors

males total

Obesity (2008) 21.0% 20.9%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity No No Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

20.9%

Total population: 8 4 4 000

Proportional mortality (% of total deaths, all ages, both sexes) Age-standardized death rates

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 47%

6.3 25.5%

Total deaths: 78,000

NCDs are estimated to account for 92% of total deaths.

0 50 100 150 200 250 300

2000 2002 2004 2006 2008 2010 2012

0 2 4 6 8 10 12

2000 2002 2004 2006 2008 2010 2012

0 2 4 6 8 10 12

2000 2002 2004 2006 2008 2010 2012

43%

Cancers 27%

4%

Diabetes 4%

Other NCDs 14%

3%

Injuries males 5%

females

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Azerbai an

Percentage of population living in urban areas: 53. % Income Group: pper middle Population proportion between ages 30 and 70 years: 44.3%

Premature mortality due to NCDs*

23% .

Adult risk factors

males total

Obesity (2008) 15.1% 23.8%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity No No Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets No Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

31.4%

Total population: 9 309 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 1%

1.1 29.8%

Total deaths: 58,000

NCDs are estimated to account for 84% of total deaths.

0 100 200 300 400 500 600 700

2000 2002 2004 2006 2008 2010 2012

0 2 4 6 8 10 12 14 16

2000 2002 2004 2006 2008 2010 2012

0 2 4 6 8 10 12 14 16

2000 2002 2004 2006 2008 2010 2012

54%

Cancers 15%

3%

Diabetes 2%

Other NCDs 10%

11%

Injuries males 5%

females

(25)

ahamas

Percentage of population living in urban areas: 84.3%

Income Group: High Population proportion between ages 30 and 70 years: 47.7%

Premature mortality due to NCDs*

14% .

Adult risk factors

males total

Obesity (2008) 26.4% 34.7%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity No No Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets No Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets es

42.4%

Total population: 372 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females . . . 3.9 24.7%

Total deaths: 2,200

NCDs are estimated to account for 72% of total deaths.

0 50 100 150 200 250 300 350 400

2000 2002 2004 2006 2008 2010 2012

0 50 100 150 200 250 300 350 400

2000 2002 2004 2006 2008 2010 2012

0 50 100 150 200 250 300 350 400

2000 2002 2004 2006 2008 2010 2012

33%

Cancers 17%

1%

Diabetes 7%

Other NCDs 14%

20%

Injuries males 8%

females

(26)

ahrain

Percentage of population living in urban areas: 88.7%

Income Group: High Population proportion between ages 30 and 70 years: 49.1%

Premature mortality due to NCDs*

13% .

Adult risk factors

males total

Obesity (2008) 29.5% 32.9%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity es es Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach es Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

38.0%

Total population: 1 318 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 8%

1.0 26.6%

Total deaths: 2,800

NCDs are estimated to account for 78% of total deaths.

0 50 100 150 200 250 300 350

2000 2002 2004 2006 2008 2010 2012

0 100 200 300 400 500 600 700 800

2000 2002 2004 2006 2008 2010 2012

0 100 200 300 400 500 600 700 800

2000 2002 2004 2006 2008 2010 2012

26%

Cancers 13%

6%

Diabetes 13%

Other NCDs 20%

10%

Injuries males 12%

females

(27)

angladesh

Percentage of population living in urban areas: 28.4%

Income Group: Low Population proportion between ages 30 and 70 years: 37.3%

Premature mortality due to NCDs*

18% .

Adult risk factors

males total

Obesity (2008) 0.9% 1.1%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity es es Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach es Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets No

1.3%

Total population: 155 000 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 2%

0.0 23.6%

Total deaths: 88 ,000

NCDs are estimated to account for 59% of total deaths.

0 50 100 150 200 250

2000 2002 2004 2006 2008 2010 2012

0 20 40 60 80 100 120 140 160

2000 2002 2004 2006 2008 2010 2012

0 20 40 60 80 100 120 140 160

2000 2002 2004 2006 2008 2010 2012

17%

Cancers 10%

11%

Diabetes Other NCDs 3%

18%

32%

Injuries males 9%

females

(28)

arbados

Percentage of population living in urban areas: 44.4%

Income Group: High Population proportion between ages 30 and 70 years: 52.4%

Premature mortality due to NCDs*

14% .

Adult risk factors

males total

Obesity (2008) 22.5% 34.7%

National systems response to NCDs

Has an operational policy, strategy or action plan to reduce physical inactivity and/or promote physical activity es es Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets es Has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach No Has an NCD surveillance and monitoring system in place to enable reporting against the nine global NCD targets es

45.9%

Total population: 283 000

Proportional mortality (% of total deaths, all ages, both sexes)*

Age-standardized death rates*

The probability of dying between ages 30 and 70 years from the 4 main NCDs is

females 2%

4.0 31.7%

Total deaths: 1,800

NCDs are estimated to account for 84% of total deaths.

0 50 100 150 200 250

2000 2002 2004 2006 2008 2010 2012

0 50 100 150 200 250 300 350 400

2000 2002 2004 2006 2008 2010 2012

0 50 100 150 200 250 300 350 400

2000 2002 2004 2006 2008 2010 2012

28%

Cancers Chronic respiratory 29%

diseases 2%

Diabetes 9%

Other NCDs 16%

11%

Injuries males 5%

females

2014 Country Proﬁles Noncommunicable Diseases

Noncommunicable Diseases

Country Profiles 2014

Noncommunicable Diseases

Country Profiles 2014

1.Chronic Disease - epidemiology. 2.Chronic Disease - prevention and control. 3.Chronic Disease - mortality. 4.National Health Programs. 5.Program Evaluation. I.World Health Organization.

ISBN 978 92 4 150750 9 (NLM classification: WT 500)

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Table of contents

Acknowledgements Foreword

Explanatory notes

- Background - Demographics - Mortality

- Adult Risk Factors

- National Systems Response to NCDs - References

Country profiles

6 7 9

9

9

9

10

11

13

14

Acknowledgements

This report was prepared by Leanne Riley and Melanie Cowan.

Sincere thanks to all Member States for their assistance with the assessment of the national systems response

component of this report.

Foreword

WHO’s Programme Budget 2014-2015 includes a dedicated budget line to provide technical assistance to countries in their efforts to set national targets for NCDs, develop national action plans, and monitor results.

In other words, more and more countries are getting the basics in place.

To provide the foundation for further advocacy, policy development and action, this report provides an overview of the current status of NCDs in each WHO Member State. The report assesses each Member State’s unique situation in face of the growing threat posed by NCDs.

It includes for each country, where available, estimates on the current burden and recent trends in NCD

mortality, prevalence of selected major risk factors, and the national systems capacity to respond to the

NCD challenge of epidemic proportions. Data in this report are drawn from multiple sources including data

provided by countries, estimates developed by WHO and the results of the global survey on assessment of

Dr Oleg Chestnov

Assistant Director-General

World Health Organization

Explanatory Notes

BACKGROUND

DEMOGRAPHICS

MORTALITY

Causes of death were estimated for 2000-2012 using data sources and methods that were specific for

each cause of death (5). Vital registration systems which record deaths with sufficient completeness and

quality of cause of death information were used as the preferred data source. Mortality by cause was

estimated for all Member States with a population greater than 250,000. Those countries with an asterisk

(*) on their profile have mortality data which are not based on any national NCD mortality data. These

NCD mortality estimates are based on a combination of country life tables, cause of death models, regional

cause of death patterns, and WHO and UNAIDS programme estimates for some major causes of death

(not including NCDs). Detailed information on methods for mortality and causes of death estimates were

published previously (5).

injuries; cardiovascular disease; cancer; chronic respiratory disease; diabetes; and other NCDs is reported for 2012 (5).

Five-year death rates were then translated into the probability of death for each NCD using the following formula:

The unconditional probability of death, for the 30-70 age range, was calculated last:

ADULT RISK FACTORS

Definition of indicators

Prevalence estimates are given for the following behavioural and metabolic risk factors:

• Current tobacco smoking (2011): the percentage of the population aged 15 or older who smoke any tobacco products.

• Total alcohol per capita consumption, in litres of pure alcohol (2010): consumption of pure alcohol (recorded and unrecorded) per person aged 15+ during one calendar year.

5

M

= Total deaths from four NCD causes between exact age (x) and exact age (x+5)

Total population between exact age (x) and exact age (x+5)

• Raised blood pressure (2008): the percentage of the population aged 25 or older having systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg.

• Obesity (2008): the percentage of the population aged 20 or older having a body mass index (BMI)

≥30 kg/m2.

Methods of estimation

NATIONAL SYSTEMS RESPONSE TO NCDS

“ND” (No Data) for all CCS related fields in this section of the profile.

Responses related to the NCD surveillance and monitoring systems were checked against three separate

sources. The information on mortality was checked against data on vital registration systems held within

WHO in the Department of Health Statistics and Informatics. The responses on cancer registries were

checked against information held at the International Agency for Research on Cancer (IARC). Information on

recent NCD risk factor surveys were checked against internal survey tracking systems for WHO-supported

risk factor surveys, including WHO STEPS (adult risk factor surveillance), the Global School-based Student

Health Survey (GSHS), and the Global Youth Tobacco Survey (GYTS) held in WHO’s Prevention of

Noncommunicable Diseases Department. Where discrepancies were noted between the country response