China’s Response to NCDs Dr. Xiaoming Shi, M.D.,MPh. Director, Division of NCDs Control and Community Health, China CDC

Behaviral Risk Factors of NCDs Behavioral Risk Factors of NCDs among 18-year-old and above 80.9% 83.4% 52.8% 47.0% 2010年的中国慢病行为危险因素监测的数据显示，摄入过多的盐、油是非常突出的问题。80.9%的家庭人均每日食盐摄入量超过5克； 83.4%的家庭人均每日食用油摄入量超过25克。中国男性吸烟率略有下降，从2007年的50.3%下降到2010年的 47.0%。 我国居民经常锻炼的比例仍然很低，18岁及以上居民中仅11.9%人经常锻炼。但，我国的监测数据显示18岁及以上居民中过量饮酒的比例不高。 17.4% 11.9% Proportion of consuming <400 g F & V Male current daily smoking rate Proportion of consuming salt>5 g per day Proportion of consuming oil >25 g per day Proportion of alcohol overconsumption proportion of doing PA regularly Doing physical activity regularly: doing recreational physical activity at least 3 times a week, and at least 10 minutes per time. Source：2010 PRC BRFSS

Populations with physiological RFs 305 million 236 million 120 million 96.8 million 中国慢病行为危险因素监测显示，超重肥胖率呈明显上升趋势。2010年的数据显示，超重率约30%，肥胖率约10%；而糖尿病的患病率达到9.7%。 32.9 million Overweight Obesity Hypertension Raised cholesterol Diabetes Source：2010 China Annual Cardiovascular Report（Hypertension）; 2010 PRC BRFSS （Overweight、Obesity、Raised cholesterol、Diabetes）.

Proportions of NCDs deaths

NCDs Prevention and Control System: Within health sectors 这个是我们国家的慢性病防治工作网络。其中一个主要力量是全国的疾控系统。

Main achievements Government Commitment to NCDs Policy formulation 5th Plenary Session, 17th National People’s Congress Strive for securing and improving people’s living Promote equal access to essential public health services 12th Five Year Plan Increase the average life expectance by 1 year within the next 5 years. Policy formulation China is implementing the FCTC, and Harbin passed the law on public place smoking ban which meets the FCTC requirements. China is implementing the Regulation on Physical Fitness formulated by the State Council. China is implementing the Ban on Smoking in Public Places

Health insurance schemes coverage Health Care Reform Provides Policy and Financial Support for NCDs Coverage of Basic Health Insurance System 31.3US$ 3.1US$ Health insurance schemes coverage NRCMS 截至目前，基本医疗保障制度基本实现全覆盖。基本医保参保率达到95%。政府对新农合的人均补助也增加了10倍。 通过实施国家基本药物制度，基本药物价格下降了30-40%。 另外，中国通过开展基本公共卫生服务和重大公共卫生服务专项，促进基本公共卫生服务均等化。基本公共卫生服务提供10项服务，人均投入达到3.9美元。这10项服务中有4项有关慢病：(1)居民健康档案; (2)65岁以上老年人健康检查; (3)高血压; (4)糖尿病等慢性病管理。重大公共卫生服务专项对慢病的投入也逐年增加，从78万美元增加到3850万美元，约50倍。 Essential Medicine Policy Public Health Services Programs lowering down the price of common essential drugs by 30 to 40 percent Essential public health services programs: 3.9US$ per person Priority public health services (NCDs）investment 780 000 US$ 38.5 Million US$

Healthy Cities Tangshan Shandong Changchun Hangzhou Dalian Yichun Kelamayi Zhangjiagang Beijing Chongqing Shanghai Guangzhou Chengdu Suzhou Panzhihua Ten Year Action Plan for Health Promotion（public access to exercise facilities, free hypertension screening at pharmacies Health education, services, food, physical and cultural activities/entertainment, environment, so-called 5 health related engineering Government takes leadership Multisectors collaboration Evidence-based approach Healthy CQ, SH, GZ, CD, SZ and PZH, etc. Community-based activities Healthy City initiative has been led by local governments, serves a vehicle/ platform for NCD prevention and control. Up to now, health city initiative has been implemented in a number of cities. For instance, healthy Shanghai, health Chongqing, and healthy Shandong, etc. Peer education Whole society participation 8 8

The 12th-Plan on Healthy Beijing Government commitment Healthy Beijing as a new strategy and new action of the capital city development Health perspective of developing public policy view point of health promotion, Health in all policies (HiAP) Establishing the mechanisms of health impact evaluation To evaluate potential health effects and risks of major capital construction projects, public policy, legislation Developing 35 health-promoting core evaluation indexes including social, economic, environmental, urban safety Focusing on controlling the social impact factors of health: noise, pollution, sewage, garbage, road traffic and accidents in production

Demonstrational Sites for Integrated NCDs Prevention and Control Most importantly, local government takes the leadership; multisectors gets involved. Implementing comprehensive prevention-oriented services, to promote healthy lifestyles Collect and disseminate best practices At the first phase, central government supported 46 counties/districts, 自2010年开始，我们开展了慢病综合防治示范区工作。这项工作关键是落实政府和部门的职责。目前全国47个县（区）申报国家慢病综合防治示范区。我们希望以慢病综合防治示范区为抓手推动中国的慢性病防控工作。

Healthy Lifestyles for All Initiative 50%~100% 0%~9% 10%~29% 30%~49% All the provinces in China launched. Covered 39.9% of counties/districts across China Up to date Over 3500 Model communities/workplaces were implemented Over 1000 Supportive physical environment were implemented “Health Gas Station" was implemented in some province. 全民健康生活方式行动是一项针对全人群的健康促进项目。这个项目通过提高全民的健康意识，创建支持性环境，促进全民健康生活方式。这个行动已经覆盖全国27%的县（区）。在第一阶段，这个行动主要关注膳食和身体活动。从2011年起，这个行动扩展内涵，增加了控烟、限酒、伤害预防、口腔、合理用药等内容。 11

Shandong Salt Reduction and Hypertension Control Program(2011-2015)

Hypertension and Diabetes Management Hypertension and Diabetes management has been included in Essential Public Heath Services. Hypertension Diabetes 42 million 35.5 million 14.8 million 10.8million 9.2 million 高血压、糖尿病管理是基本公共卫生服务的主要工作内容之一。自2009年7月开始在基本公共卫生服务开展高血压病人、糖尿病人管理。从2009年，通过基本公共卫生服务管理的高血压病人、糖尿病人逐年增加。截至2011年6月，通过基本公共卫生服务均等化，管理了高血压病人4200万人，糖尿病人1084万人。 4.6 million

Incremental Progress Salt intake for each person per day g/day Chinese Dietary Guideline Recommended Intake (6g) 中国的慢病防控已经看到了阶段性成果。根据全国营养调查和2010年中国慢病行为危险因素监测的数据，中国居民食盐摄入量正在逐步下降。 Urban area Rural area (Year) Salt intake for each person per day Data source: Nutritional Survey; PRC BRFSS

Incremental Progress Current smoking rates among Chinese aged 15- to- 69 year-olds 中国15-69岁居民系在吸烟率无论是男性、女性，还是城乡都呈现下降趋势。 Male Female Urban Area Rural Area (Year) Source: Yang Gonghuan, Hu Angang. “Tobacco Control and Future of China”

Challenges of NCDs Prevention and Control Faced by China Although China has done a lot of work, we still have many difficulties in winning this battle. We need to learn from other countries. Uneven distribution of health resources Imperfect health information system Weak capacities of health workforce Insufficient basic health facilities Inadequate financial resources for NCDs Uncoordinated response to NCDs 尽管中国做了很多的工作，中国仍然面临很多的困难。我们需要向其他国家学习，需要与其他国家的帮助。

Next steps National Strategy on NCDs Control and Prevention Involved 15 ministries, to be issued in June 2012 National Action Plan on specific NCDs including CVDs, diabetes, Cancers, COPD and Risk Factors Monitoring and Evaluation National Surveillance Framework and its implementation Monitoring diseases, risk factors and social determinants Implementing National Surveillance, Intervention, Management, Health Promotion Programs Advocate political will and establish efficient multi-sector collaboration mechanism Promote legislation on tobacco ban in Public Places at national, provincial and city level Mobilize food production and processing company

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