Toward a National Master Plan for Improved Implementation and Monitoring of NCD Prevention | 203
improving diet, and increasing physical activity helps to reduce the biological risk factors (table 9.1) and the incidence of four main NCDs: cardiovascular diseases, diabetes, chronic respiratory diseases, and some cancers. These NCDs are not only among the leading causes of death in Saudi Arabia (IHME 2020), but also the main focus of the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 (WHO 2013). COVID-19 has shown that tackling NCDs also is fundamental to health security (NCD Alliance 2020). Only those cancers that are linked to the three behavioral risk factors should be prioritized. Epidemiological evidence suggests that consuming vegetables, fruits, and a fiber-rich diet can prevent certain types of cancer (colon, rectum, esophagus), while fat-rich diets (especially diets rich in red and processed meats) increase the risk of other specific types of cancer (breast, colon, rectum) (IHME 2020). The master plan therefore will provide guidance on how to reduce several important cancers in the long term. When setting the overarching strategic goal of the multisectoral prevention of NCDs in the country, the time lag for cancers should be taken into account. For cancers with strong risk modifiers, trends of risk factors are followed by trends of cancer incidence with a lag of 20–30 years (Gelband et al. 2015). Smoking-related interventions, in the same way as dietand physical activity–related ones, take more than a decade to affect the incidence and prevalence of lung cancer (Tindle et al. 2018). Many other conditions of public health importance are closely associated with the four major NCDs; however, not all can be addressed at once. The WHO Global Action Plan (WHO 2013) lists these other conditions as mental disorders, disabilities (including blindness and deafness), violence and injuries, and other NCDs (renal, endocrine, neurological, hematological, gastroenterological, hepatic, musculoskeletal, skin, and oral diseases as well as genetic disorders) without recommending that this extended list of conditions should necessarily be the target of a national NCD strategy. It also recognizes that NCDs and their risk factors have strategic links to health system–related initiatives and universal health coverage; environmental, occupational, and social determinants of health; communicable diseases; maternal, child, and adolescent health; reproductive health; and aging. Despite these close links, the WHO’s Global Action Plan cautions against developing NCD implementation plans addressing all of these issues in equal detail, as doing so would make the plans unwieldy and unlikely to be implemented successfully (WHO 2013). Saudi Arabia’s master plan, with its focus on a narrow, implementable scope of prevention interventions, will not initially cover these additional NCDs, since its sole aim will be to achieve high-impact, measurable outcomes.
PRIORITIZING PREVENTION OVER TREATMENT The master plan will focus on prevention over treatment. The Political Declaration of the United Nations General Assembly (2012) recognizes prevention as the cornerstone of the global response to NCDs. Reducing the exposure of individuals and populations to the behavioral risk factors for NCDs while strengthening their capacity to make healthier choices and adopt lifestyles that foster good health are critically important in the prevention of NCDs. The literature identifies which NCD prevention interventions are the most effective and cost-effective (see chapter 7). In addition, focusing on prevention rather than
