UN Task Force on NCDs: Joint UN action to respond to NCDs epidemic in Mongolia
ULAANBAATAR, 24 September 2015 - Two related United Nations missions visited Mongolia from 7-11 September to support the government in reducing premature deaths from noncommunicable diseases (NCDs), a country where the probability of premature death is 32%.
Mongolia became the second country in the WHO Western Pacific Region to receive the Joint Mission of the UN Interagency Task Force on the Prevention and Control of NCDs. The mission included representatives from the World Health Organization (WHO), United Nations Food and Agriculture Organization (FAO), United Nations Development Programme (UNDP), United Nations Children's Fund (UNICEF), United Nations Population Fund (UNFPA) and the Asian Development Bank (ADB).
The second mission led by the WHO Framework Convention on Tobacco Control (FCTC) Secretariat and the Ministry of Health and Sports conducted a needs assessment for the implementation of the FCTC. During the visit, mission members met central and local government representatives, the Head of the President’s Secretariat, the Senior Advisor on Health to the Parliament Speaker, health officials from the capital city and its districts, members of scientific and professional associations and civil society.
The missions concluded that the epidemic of NCDs, principally cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, is now a serious concern in Mongolia. Half of adult males in the country are tobacco smokers. One out of three people have raised blood pressure, and one out of five have diabetes. They also found that the main risk factors for NCDs in Mongolia are tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity.
“Usually one or the other of the four risk factors are found to be prevalent in a given country. But Mongolia is unique with all four risk factors on the rise,” says Dr Nick Banatvala from WHO in Geneva.
The Joint Mission welcomed the Second National Programme on Prevention and Control of Diseases Caused by Unhealthy Lifestyles 2014-2021 for setting out an approach for all parts of government to work together to combat the NCDs epidemic. However it also advised that the Programme could be strengthened by prioritizing actions on NCDs prevention and control and costing such actions.
Overall the experts mentioned that coordination mechanisms within the government and accountability at the political level should be improved.
“One conclusion of a recent review of progress in Mongolia carried out for WHO NCD Progress Monitor 2015 is that action implementing cost-effective policies to reduce NCD risk factors needs to be stepped up,” says Dr Banatvala. “The government recognizes that it cannot manage the ever-increasing burden of NCDs by treating people with these conditions and, therefore, prevention is now the first priority,” says G. Shiilegdamba, the Minister of Health and Sports of Mongolia, stressing the importance of further collaboration with the UN agencies on reduction of NCDs. “A whole-of-government, whole-of-society is now required to tackle the four main NCD risk factors,” says Dudley Tarlton, the programme specialist with the UNDP office in Geneva. “This requires a whole-of-UN response to help the government in building national NCD solutions”, he added.
“There are a number of inspirational activities and projects on NCD prevention that the province and city district governments had been undertaking,” says Ch. Tsendsuren, the Chair of the Darkhan-Uul province’s local parliament. He brings an example of the “Healthy City” programme initiated by the Darkhan city mayor in 1996-2012 with further extension to 2015 that aimed at creating healthy living environments in urban and rural areas of the province and promotion of healthy lifestyles in communities, families, and for individuals.
The FCTC implementation assessment mission applauded the comprehensive revisions made to the law on tobacco control by Mongolia in 2013 which was first adopted soon after Mongolia’s ratification of the FCTC in 2003. Currently, smoking is prohibited in many public places such as schools and restaurants, and advertising of tobacco is banned. Sale of tobacco is also banned within 500 metres of secondary schools and student dormitories.
However, the mission also pointed at the missing parts of the law implementation, as accessibility and availability of tobacco products and the lack of health promotion. A further revision of the law in 2015 allowed designated smoking areas in public places, which eroded gains being made in tobacco control in the country.
“The tobacco industry is an experienced and powerful enemy that uses all possible means to keep people smoking,” says Dr Carmen Maria Audera-Lopez of the FCTC Secretariat.” So the law should be combined with strong and continued health promotion efforts to inform people about the harm from smoking and second-hand smoke.”
The FCTC mission advised Mongolian authorities to re-establish the suspended Health Promotion Foundation, which was funded by 2% of excise taxes on alcohol, tobacco and drugs, and to then channel the resources to the public health sector including health promotion.
“Both the prices of and taxes on alcohol and tobacco are very low in Mongolia in comparison with other countries,” says parliamentarian L. Erdenechimeg, the initiator of the 2013 comprehensive revisions to the Tobacco Control Law and the Chair of the Women’s Caucus in the parliament. “Hence we will push for re-establishing the Health Promotion Foundation during the upcoming discussion of the next year’s budget.”
She stressed the need to make high-level decisions on alcohol and tobacco control and bring necessary changes to the Law.
WHO’s Representative to Mongolia, Dr Soe Nyunt U, says important developments that can improve the NCD situation in this country, are in place including the adoption of the Sustainable Development Goals, and the new UN Development Action Framework being drawn up by UN organizations in Mongolia to support development, including health, for 2017-2021.
“The SDGs, Goal 3 specifically, aim to ensure healthy lives and promote well-being of all people at all ages. So WHO and UN partners will work as a team to support Mongolia in reducing premature deaths from NCDs,” says Dr Soe Nyunt U, WHO Representative in Mongolia.
NCDs in MONGOLIA
- The probability of dying prematurely, between ages 30 and 70, from the four main NCDs is 32%.
- Cardiovascular disease is the leading cause of death with 43%, followed by cancers (17%), other NCDs, like chronic respiratory disease and diabetes (15%), and injuries (11%).
- In 2013, 49.1% of men and 5.3% of women currently use tobacco. Among adults aged 15-64, 40.9% (36% of men and 45.8% of women) were exposed to second-hand smoke in homes.
- In 2014, 20.3% of male students and 8.3% of female students aged 13-15 currently use any tobacco. Among students surveyed, 42.4% reported being exposed to tobacco smoke at home, and 49.8% reported being exposed to tobacco smoke in public places.
- Total alcohol per capita consumption in 2010 in males was 11.7 litres of pure alcohol, whereas in females 2.2 litres, indicating another major difference in living habits between men and women in Mongolia.
- The prevalence of raised blood pressure in 2008 in males was 38.1% and in females 27.5%. Obesity rate in 2008 in males was 10.4% and in females 18.3%. (WHO Mongolia Country Profile, 2014.)
PROGRESS IN NATIONAL NCD REPONSE BOX
- National NCD targets and indicators – fully achieved
- Mortality data – partially achieved
- Risk factor surveys – fully achieved
- National integrated NCD policy/strategy/action plan – fully achieved
- Tobacco demand-reduction measures:
- Taxation – not achieved
- Smoke-free policies – fully achieved
- Health warnings – fully achieved
- Advertising bans – partially achieved
- Harmful use of alcohol reduction measures:
- Availability of regulations – partially achieved
- Advertising and promotion bans – partially achieved
- Pricing policies – partially achieved
- Unhealthy diet reduction measures:
- Salt/sodium policies – not achieved
- Saturated fatty acids and trans-fats policies – not achieved
- Marketing to children restrictions – not achieved
- Marketing of breast-milk substitutes restrictions – fully achieved
- Public awareness on diet and/or physical activity – fully achieved
- Guidelines for the management of major NCDs – partially achieved
- Drug therapy/counselling for high-risk persons – not achieved
For further information, please contact:
Ms Nomin Lkhagvasuren
Communication and Health Promotion
WHO Country Office, Mongolia
Mr Paul Garwood
Telephone: +41 79 603 7294