WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
WELTGESUNDHEITSORGANISATION Date: 18 July 2023
ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ
REGIONAL OFFICE FOR EUROPE Ms Elen Ohov
BUREAU RÉGIONAL DE L’EUROPE
REGIONALBÜRO FÜR EUROPA
Adviser
ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО European Union Affairs and International Co-
Head office:
operation Department
UN City, Marmorvej 51, Ministry of Social Affairs
DK-2100 Copenhagen Ø, Denmark Suur-Ameerika 1
Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01
Email:
[email protected] 10122 Tallinn
Website: https://www.who.int/europe Estonia
Our reference: Your reference:
Notre référence: Votre référence:
Unser Zeichen: Ihr Zeichen:
См. наш номер: На Ваш номер:
Dear Ms Ohov,
WHO European regional consultation:
Noncommunicable diseases (NCDs) in emergency preparedness and response
5-6 September 2023
The WHO European Regional Office plans to conduct a two half-day above-mentioned regional
consultation on 5-6 September 2023 as a hybrid meeting (online/offline).
The main objectives for the consultation are to make the case for integration of NCDs as part of general
Preparedness 2.0 plan; to identify gaps, challenges and lessons learned across the WHO European
region; to consider which tools are available to provide support for MS; to identify potential short-terms
priorities and long-term vision for collaboration between NCD and Health Emergency colleagues. In
addition, this meeting helps to further act as a kick-off for a Global High-level meeting on addressing
NCDs in emergency preparedness and response planned later in February 2024.
As part of the consultation process, participants will have the opportunity to work in groups (virtually
or in person) in different aspects of NCD emergency response and form next steps and general
recommendations for the region.
The regional meeting will bring together representatives of Member States and focal points from health
emergency, NCD, health systems and public health areas, experts in academic, research and public
health area, non-state actors and international financial institutes and health partners, WHO HQ, country
offices.
I am pleased to invite you to nominate a team of country focal points to participate in the regional
consultation, in particular Ministry of Health official, an expert in NCD prevention and control, an
expert in health emergencies, and an expert in the health systems strengthening.
We look forward to receiving your country’s nomination with the names, official position and titles,
and email addresses of the proposed participants, at your earliest convenience.
Please find attached Scope and purpose and Provisional agenda of the consultation.The working
language will be English and Russian (simultaneous interpretation will be provided).
UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email:
[email protected]
DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: https://www.who.int/europe
Denmark
We would be grateful if your response will be addressed to Dr Elena Tsoy, Technical officer on NCD
management, by email
[email protected] with copy to Alex Monich
[email protected] as soon as
possible, but not later than 4 August 2023.
Sincerely yours,
On behalf of
Dr Gauden Galea,
Special Advisor to the Regional Director,
Special initiative on noncommunicable diseases and innovation (SNI)
WHO European Regional Office
Encls:
Scope and purpose
Provisional agenda
Copy for information to:
Ms Triin Uusberg, Head, European Union Affairs and International Co-operation Department, Ministry of
Social Affairs, Suur-Ameerika 1, 10129 Tallinn, Estonia
H.E. Ms Katrin Saarsalu-Layachi, Ambassador Extraordinary and Plenipotentiary, Permanent Representative,
Permanent Mission of the Republic of Estonia to the United Nations Office and other international
organizations in Geneva, Chemin du Petit-Saconnex 28A, CH-1209 Genève, Switzerland
H.E. Mr William Mart Laanemäe, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of
Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark
Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia
–2–
WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ
REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L'EUROPE
WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ
REGIONALBÜRO FÜR EUROPA ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО
WHO European regional consultation: /4
Noncommunicable diseases (NCDs) in
emergency preparedness and response
Event format: hybrid (online/offline)
Date: 5-6 September (9am-12.30pm CET)
[12 July 2023]
Original: English
Concept note
Background
1. NCDs such as cardiovascular disease, cancer, chronic respiratory disease and diabetes are the most common
cause of death and disability across Europe. They account for 90% or 9 million deaths each year across the
region and around 85% of disability adjusted life years. Many of these deaths are premature with one in five
deaths in men under the age of 70 years and one in every ten deaths in woman a result of NCD. The vast
majority are undiagnosed and many more are at risk of developing a NCD due to biological, environmental
and lifestyle risk factors. This high burden as a pre-crises situation also has major health impact during
humanitarian crises and health emergency conditions.
2. The last ten years have seen growing interest in the need to better integrate NCDs into emergency
preparedness and response, which traditionally has tended to focus more on communicable diseases, trauma
and injuries. With a growing proportion of the population at risk of and living with NCDs there is a need to
readdress this balance, particularly given the global nature of crises in the world today – the world in the
state of permacrisis.
3. This concept note describes the rationale and plan for Consultation with Member States of the European
Region on strengthening the integration of noncommunicable diseases into emergency preparedness and
response. This consultation is being held in response to recommendations agreed by MS at the 75th World
Health Assembly (A75/10 Add 2 Annex 4). Recommendations included “review current WHO NCD-related
responses in countries in emergencies and suggest a strategic approach to improving WHO technical
assistance to countries across preparedness, response and recovery, leveraging crises as an entry point to
build health systems back better through development of sustainable NCD services”. In line with this
recommendation, WHO EURO initiated an operational review with country case studies to drive strategic
discussions at the regional consultation.
The NCD and emergencies context
4. Whilst data on the interplay between emergencies and NCDs is scarce it is estimated that events such as
heart attacks and strokes are two to three times more common than in non-emergency circumstances. In
addition, emergencies can lead to an acute exacerbation or deterioration in the health of those affected by
NCDs due to trauma leading to acute respiratory, cardiac and renal events, disruption of access to medicines
or assistive devices due to displacement or damage to infrastructure, loss of normal living conditions and
social structures and interruption of care. In addition, emergencies can lead to those undiagnosed or untreated
suffering an acute event.
5. This correlation between emergencies and NCDs was further highlighted during the global pandemic of
SARS Co-V. In December 2020 the UNGA noted in resolution 75/130 that people living with NCDs were
more susceptible to the risk of developing severe COVID-19 symptoms and were the most affected by the
pandemic. It also recognised that necessary prevention and control efforts were being hampered by lack of
universal access to quality, safe, effective and affordable essential health services, medicines, diagnostics
and health technologies as well as a global shortage of qualified health workers. Disruption to health services
resulted in lack of follow up and monitoring for those living with a NCDs, late diagnosis and consequent
advanced disease stage, interrupted or delayed treatment and worsening behavioural risk factors. The lack
of data systems for documenting death and disabilities made it hard to collect accurate, complete and timely
data was noted, along with the observation that this made it hard to understand the impact of COVID-19 on
those living with or at risk of NCDs.
6. The WHO Europe region has seen at least three Grade 3 emergencies (COVID-19, the war in Ukraine and
2023 earthquake in Turkey and the surrounding region) in the last three years showing that no region is
exempt from health crises. These along with recurrent heat waves, dry weather conditions, forest fires, dust
storms, floods and the potential for other emergencies such as volcanic eruptions and other events, make
preparedness and resilience work for those with and at risk of NCDs even more critical. The WHO-Europe
region has identified 15 countries and territories in the European Region (Albania, Armenia, Azerbaijan,
Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, North Macedonia, Republic of Moldova,
Serbia, Tajikistan, Turkey, Ukraine, Uzbekistan, and Kosovo territory) at greater risk from health
emergencies both in terms of likelihood of exposure to a significant hazard and their health system ability to
manage and respond to the impact.1
Policy context
7. NCDs were first incorporated into emergency planning and response guidelines in 2011 as part of the
SPHERE disaster response guide and was further edited and strengthened in 2018.
8. The 2013 Political Declaration of the United Nations General Assembly High Level Meeting on prevention
and control of NCDs recognised ‘the importance of universal health coverage through primary health care
and social protection to provide access to health services for all, in particular the poorest segments of the
population.’ It noted that ‘for comprehensive care of NCDs all people require access, without
discrimination, to a nationally determined set of promotive, preventive, curative, rehabilitative, and
palliative basic health services… without exposure to financial hardship and… ensuring the continuity of
care in the aftermath of emergencies and disasters.’ The accompanying 2013 GAP report recommended
that the secretariat provide ‘support to countries in evaluating and implementing evidence-based options….
in assessing the health impact of public policies… and maximising intersectoral synergies for the
prevention and control of NCDs across programmes… for addressing NCDs during disasters and
emergencies’ by ‘establishing or strengthening national reference centres, WHO collaborating centres and
knowledge sharing networks.’
9. Specific policy and technical actions included asking the secretariat to develop and deploy an interagency
emergency health kit for the treatment of NCDs in humanitarian disasters and emergencies and MS to
improve availability of life saving technologies and essential medicines for managing NCDs in the initial
phase of emergency response. In 2018 the Political declaration of the third high level meeting of the General
Assembly on the prevention and control of NCDs was adopted committing Heads of State and Government
and representatives to ‘Strengthen the design and implementation of policies, including for resilient health
systems and health services and infrastructure to treat people living with NCDs and prevent and control
their risk factors in humanitarian emergencies, including before, during and after natural disasters with a
particular focus on countries most vulnerable to the impact of climate change and extreme weather events.’
10. Following the onset of the pandemic of SARS Co-V virus in 2020 several policy reviews and resolutions
were formed in part in response to data emerging on increased risk of severe COVID-19 for those living
with NCD. This included the mid-term evaluation of the GAP report which noted that COVID-19 had
occurred at a time when the response to NCDs was already ‘precarious and on the backdrop of
underinvestment in prevention, early diagnosis, screening, treatment and rehabilitation’ with efforts to
tackle NCDs dwindling since 2010. It also noted that in some settings COVID-19 was happening on the
background of other concurrent emergencies and the importance of preparedness. It stated that ‘more is
needed to ensure NCDs are managed effectively through primary care so that people with NCDs, such as
hypertension and diabetes, are diagnosed, treated and have their conditions controlled.’ And that ‘There is
a need to ensure that vulnerable groups, different age groups and those in emergency settings are included
in this provision,’ It also noted that the UN Interagency Task Force convened to bring together a number of
1
Priority countries for core capacity strengthening (https://www.who.int/europe/emergencies/our-work-in-emergencies/priority-countries ,accessed
January 12,2023)
UN Agencies around the issue of NCDs had established thematic groups to enable member agencies to pool
together resource more effectively. This included a Task Force focused on NCDs and emergencies but that
despite this there needed to be more focus on ‘securing a continuum of care for NCD patients in refugee or
displaced situations.’ It noted that a working group had been set up, but no concrete progress made. MS also
called for more guidance on delivering NCD programmes during emergencies and the report noted the need
to build bridges between national humanitarian emergency plans and NCD responses.
11. In December 2020 the United Nations General Assembly adopted resolution 75/130 on Global health and
foreign policy: strengthening health system resilience through affordable care for all. It noted the increasing
number of complex emergencies that are hindering achievement of UHC and that coherent responses to
safeguard UHC in emergences were needed. It also noted that NCDs were the leading cause of premature
death and disability globally including in low- and middle-income countries with those living with NCDs at
increased risk of developing severe COVID-19.
12. In April 2022 the follow up to the political declaration of the high-level meeting of the General Assembly
on the prevention and control of non-communicable diseases A75/10 Annex 4 was adopted. This focused on
strengthening the design and implementation of policies, including those for resilient health systems and
health services and infrastructure to treat people living with noncommunicable diseases and to prevent and
control their risk factors in humanitarian emergencies and reflected learning coming from COVID-19 and
applying this to other forms of emergency.
13. At the time of writing there were at least 73 active graded emergencies and called for a broader approach to
health emergencies, that takes an all-hazards approach. The resolution noted existing policies and
interventions that benefited those living with NCDs in humanitarian settings such as the development of the
WHO NCD kit in use since 2017 in more than 20 countries, interim guidance on essential health services
during outbreaks, and increasing interest in research on NCDs in humanitarian and emergency contexts. It
also presented a series of COVID-19 and non-COVID-19 recommendations to strengthen systems for
resilience, preparedness, response and recovery including strengthening policies and programmes, involving
those living with NCDs, ensure minimum quality services are made available, enabling access to medicines,
and developing better strategies and tools. It also called upon international partners to increase engagement
and advocacy on NCDs and all hazards approaches to emergencies, including strengthening policies,
programmes and support to MS. WHO were asked to review WHO NCD related responses in countries, to
strengthen collaboration and communication internally (across the regions) and with partners, to develop a
prioritised NCD package to be delivered in emergencies, to support countries in deploying medicines, to
support building of workforce capacity, produce technical guidelines and tools, to strengthen systems for
preparedness and response by engaging with those living with NCDs and involving in planning,
implementation and evaluation, and by shaping the research agenda.
14. In response to these recommendations a joint global landscaping review by WHO NCD and emergencies
departments was launched in January 2022 with a view to setting out strategic recommendations for
improving WHOs technical assistance to countries across the full spectrum of the emergency preparedness
and response cycle. These recommendations are forming the basis for proposals that will be built at regional
level through a series of regional and global consultations and meetings.
Proposed design for the WHO Euro regional consultation
15. This concept note sets out a strategic approach proposed for the regional consultation for the WHO European
region. This consultation aims to share best/good practices, lessons and challenges related to integration of
NCDs in preparedness and response to humanitarian emergencies in the WHO European Region; to build
political momentum for inclusion of NCD prevention and management actions in regional and country
preparedness and emergency response agenda as adopted during the 75th session of the World Health
Assembly (WHA/A75/10/Annex 4 Add.2); and to contribute to the NCD implementation road map 2023–
2030. It will bring Member States technical NCD and emergencies leads together with WHO leads, to
increase awareness of the correlation between NCDs and Emergencies, and to develop a common language
and foster connections between the two groups.
16. The meeting will be structured in three parts and as per the agenda that follows:
a. The first part will focus on ensuring participants have a joint understanding of why NCDs must be
considered to be a critical part of the emergency policies and actions, including reflections on how
permacrisis has changed current thinking around integration of NCDs into emergency planning. AT
this session, experts can share current thinking on adaptations to the Health Emergency Preparedness
Architecture such as the use of joint platforms between health systems and readiness work and joint
NCD gaps and priorities.
b. The second section will allow selected MS the opportunity to present case studies focused around
the Health Emergency Preparedness and Response Framework linked to different health systems
aspects. The country examples will be used as means to stimulate discussion on the kind of
interventions that might be considered to better integrate NCDs in emergencies.
The second part will provide an opportunity to look at what the NCD and health systems community
has learnt from emergencies over the past years, including a summary of what we know about
country capacity in this space, and findings from the operational review. It will also share thoughts
on how NCDs in emergencies have been managed to date, presenting the lessons, gaps and
achievements.
c. The first and the second parts of the consultation will set the scene for a consultation final session
will help to discuss a set of possible actions around the four stages of resilience, preparedness,
response and recovery which will close with offering Member States a joint statement on integrating
NCD in emergency response. The MS can take forward on return to their countries a set of actions
discussed. This consultation could further lead to the development of a joint NCD and emergency
framework as part of the Preparedness 2.0 and discussed at the following co-creation and co-
development expert consultations and workshops.
Objectives
17. There are specific objectives for the workshop:
To make the case for integration of NCDs as part of regional and country emergency and preparedness
response.
To develop a shared language across NCD and essential services measures in all-hazards preparedness
2.0 plan; to consider which tools are available to provide support for MS across the WHO European
region.
To identify gaps, challenges and lessons learned from both the WHO global and European regional
landscaping review of NCDs in emergencies and from country cases in the European Region.
To identify potential priorities and a vision on NCDs for collaboration between Health Systems and
Emergency response and recovery colleagues.
To enable MS representatives to define a set of actions (with technical support from WHO) that they
can take forward on return to their countries.
To elaborate a joint WHO and MS position for the European Region, ahead of the global high-level
meeting on NCDs in emergencies in Copenhagen in February 2024.
Participants
18. The consultation aims on bringing together country representatives and experts in Health emergency and
NCD prevention and management, health systems and policies areas, in particular:
Country teams will include representatives of MoH and decision makers in wider Public Health area,
focal points in both HE and NCD areas
Experts from LSHTM and OECD
Key health partners from UN and other international organizations: UNICEF, UNFPA, IOM,
UNHCR
Non-state actors: IDS, ECS, WDF, ERS
Key development partners and IFIs: NORAD, Denmark, USAID, EU/EC, Swiss Agency
Cross-cutting programmatic
WHO/EURO teams: the whole SNI, WHE, CPS, CHP/Bonn office, BCI etc. and
HQ WHE and NCD teams
WHO/EMRO colleagues
Saatja: EURO NCD <
[email protected]>
Saadetud: 18.07.2023 17:11
Adressaat: <"Elen Ohov">
Koopia: <"Triin Uusberg">; <"SM Info">; Ms K. Saarsalu-Layachi
<
[email protected]>; <
[email protected]>; Kaisa.Mitt-Alvarez
<
[email protected]>; <
[email protected]>;
<
[email protected]>; KÖHLER, Kristina <
[email protected]>; EURO NCD
<
[email protected]>
Teema: WHO European regional consultation: Noncommunicable diseases
(NCDs) in emergency preparedness and response, 5-6 September 2023
Dear Ms Ohov,
Please find attached a letter from the Special Adviser to the Regional
Director, Special Initiative on Noncommunicable Diseases and Innovation
(SNI), WHO Regional Office for Europe. Also enclosed are the Preliminary
Agenda and the Scope & Purpose.
Sincerely,
WHO Secretariat
WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ
REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L'EUROPE
WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ
REGIONALBÜRO FÜR EUROPA ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО
WHO European regional consultation: /4
Noncommunicable diseases (NCDs) in
emergency preparedness and response
Event format: hybrid (online/offline)
Date: 5-6 September (9am-12.30pm CET) 12 July 2023]
Original: English
Provisional agenda
Day 1, September 5, Tuesday
09.00 – 10.30 Welcome and official opening session
Keynote address and panel discussion
New global priorities and needs in permacrisis context
Urgency of streamlining NCD response in global preparedness and response in the
health emergencies agenda
Regional operational review: identified strengths, needs, gaps and lessons learned to
reconsider priorities in NCD and emergency area
10.30 - 11.30 Breakout session:
Presenting country cases, discuss barriers, lessons learned and exchange regional
experience in NCDs and all type of health emergencies
11.30 - 12.15 Panel discussion:
Feedback and key issues and lessons learned from each group
12.15 - 12.30 Summary of the day and wrap up
Day 2. September 6, Wednesday
09.00 – 09.45 Plenary session:
Available approaches and tools for NCD and HE preparedness and response
09.45 – 10.45 Breakout session
Development of recommendations for incorporating NCD measures in the Preparedness
2.0 - a new strategy and action plan to strengthen health emergency preparedness,
response and resilience 2024-2029
10.45 – 11.45 Moderated panel discussion and feedback from the groups
11.45 – 12.15 Plenary session:
Way forward, uniting efforts and joint recommendations in NCD
12.15-12.30 Closing remarks
Wrap up