STEPS: A framework for surveillance - WHO | …

1 WHO/NMH/ : GENERALSTEPS: A framework forsurveillanceThe WHO step wise approach to Surveillanceof noncommunicable diseases (STEPS)Noncommunicable Diseases and Mental HealthWorld Health Organization20 Avenue Appia, 1211 Geneva 27, SwitzerlandFor further information: step wise approach to NCD surveillanceiiCopies of this document are available from:Noncommunicable Diseases and Mental HealthWorld Health Organization20 Avenue Appia1211 Geneva 27 SwitzerlandFax: +41 22 791 4769 Email: content of this document is available on the Internet at: World Health Organization 2003. This document is not a formal publication of the World HealthOrganization (WHO). All rights are reserved by the Organization. The document may be freelyreviewed, abstracted, reproduced or translated, in part or in whole, but may not be sold or used forcommercial in SwitzerlandWHO step wise approach to NCD surveillanceiiTable of contentsTABLE OF surveillance OF NONCOMMUNICABLE health role of public health and noncommunicable disease of a NCD surveillance data for surveys to disease surveillance to risk factor WHO step wise approach to NCD THE EMERGING EPIDEMIC OF CHRONIC burden of chronic need to control the emerging epidemic of role of WHO in responding to the accelerating NCD THE WHO STEPWISE APPROACH (STEPS) TO surveillance OF NCD for the selection of key risk factors and disease framework for risk factor surveillance .

2 A step wise to suit local COMPONENTS OF THE WHO STEPWISE TOOL FOR surveillance OF NCDRISK 1 Questionnaire-based 2 Questionnaires and physical 3 Questionnaires, physical measures and biochemical KEY ISSUES IN PLANNING target means as statistical IMPLEMENTATION OF WHO Management Structure for STEPS as a WHO STEPS surveillance 1: LIST OF NCD surveillance DOCUMENTS European North and South Health step wise approach to NCD surveillanceivAcknowledgementsThe authors wish to acknowledge the contribution of the WHO regional Offices, through the NCDregional advisers, in the development of this report as well as a number of people from variousinstitutions and agencies who have provided input, substantive comments, or feedback on earlier draftsof this particular, the input of the following, among other who have supported the concept of the step wiseapproach to surveillance (STEPS) is gratefully acknowledged.

3 Hyppolyte Agbuton, Kingsley Akinroye, Annette Akinsete, Tim Albion, Julia Alfred, Ala Alwan,Ezzat Amine, Krishnan Anand, Craig Anderson, Martha Anker, Arora, Kjell Asplund, NahlaBaba, Albert Barcelo, Abdul Bari Abdulla, Kidist Bartolomeos, Robert Beaglehole, MohammedBelhocine, Lydia Bendib, Rafael Bengoa, Ruth Berkelman, Pedro Mas Bermejo, Bhagwat, TranHuu Bich, Steve Blair, Leigh Blizzard, Martin Bobak, Pascal Bouvet, Debbie Bradshaw, Joanna Broad,Fiona Bull, Peter Byass, Peter Callan, Dennis Calvert, Lucimar Cannon, Barbro Carlsson, VikashniChand, Jie Chen, Bernard Choi, Miriam Claeson, Alberto Concha-Eastman, Stephen Corber, MargaretCornelius, Vera Costa e Silva, Albertino Damasceno, Isabel Danel, Niklas Danielsson, Ian DarntonHill, Desai, Abolghassem Djazayery, Hind Djerrari, Annette Dobson, Kathy Douglas, TerryDwyer, Joan Dzenowagis, Anders Emmelin, Alfredo Espinosa Brito, Sarah Faletoese, Anna Ferro-Luzzi, Antonio Filipe, Noela Fitzgerald, Limbo Fiu, Sunia Foliaki, Monica Fong, Terrence Forrester,Jayne Fryer, Gauden Galea, Deborah Galuska, Elize Gershater, Jean-Pierre Gervaisoni, Mariano BonetGorbea, Vilnius Grabauskas, Robert Granger, Gupta, Rajeev Gupta, Djohar Hannoun, ToshihikoHasegawa, Richard Heller, Susilowati Herman, Dionisio Herreira, Helen Hermann, John Jabbour,Samer Jabbour, Rally Jim, Jindal, Abraham Joseph, Prashant Joshi, Umesh Kapil, Kapoor,Oussama Khatib, Robert Kim-Farley, Hilary King, Makeleta Koloi, Lingzhi Kong, Andrea Kriska,Etienne Krug, Thomas Kurian, Kerry Kutch, Kari Kuulasmaa, Louise Hayes.

4 Gael Kernen, StevensonKuartei, Justina Langidrik, H. Latiri, Jerzy Leowski, Dominique LeF vre, Xinhua Li, L. Lili'o, KipierLippwe, Alan Lopez, Heather MacDonald, Nancy Macdonald, Sarah MacFarlane, Judith Mackay,Nejma Macklai, Maga, Blerta Maliqi, Jean-Claude Mbanya, Tony Mbewu, Laura McDougall,David McQueen, Shanthi Mendis, George Mensah, Airambiata Metai, Dan Miller, Anoop Misra, , Maristela Monteiro, Alfredo Morabia, D. McDonald Mtotha, David McQueen, FerdinandMugusi, Gano Mwarewo, Shakila Naidu, Richard Nesbit, Angela Newill, Nawi Ng, Chizuru Nishida,Robyn Norton, Ayoade Olatunbosun-Alakija, Pedro Ordunez, Stipe Ore kovi , Fred Paccaud, ArvindPandey, Lili Pasat, Margie Peden, Rachel Pedersen, Janina Petkeviciene, Pirjo Pietinen, Barry Popkin,Rimina Potemkinov, Viliami Puloka, Pekka Puska, Jan Pryor, Mahmudur Rahman, Sawat Ramaboot,Lars Ramstrom, K Srinath Reddy, Peter Redert, Nina Rehn, Claude Renaud, Sylvia Robles, PazRodriquez, Gojka Roglic, Salanieta Taka Saketa, Susana Sans, Shekhar Saxena, Cristina Schneider,Jimaima Schultz, Cecilia Sepulveda, Bella Shah, Aushra Shatchkute, Prakash Shetty, N.

5 Short, PadamSingh, Sinha, Michael Sj str m, Seilini Soakai, Lakshmi Somatunga, C. Sookram, SoeharsonoSoemantri, Harley John Stanton, Krisela Steyn, Kathleen Strong, Sugathan, Hirotu Suzuki, KarenTairea, Julita Tellei, Thankappan, Benete Tokanang, Hanna Tolonen, Steve Tollman, , Thomas Truelsen, Nigel Unwin, Ulla Uusitalo, Cherian Varghese, Barbora Vozarova,Godfrey Waidubu, Stig Wall, Lepani Waqatakirewa, Franklin White, Derek Yach, Zaida Yadon, MabelYap, Helena Zabina, Paul from the Governments of Australia, the Netherlands, Sweden and the United Kingdom towardsthe development and implementation of the WHO step wise approach to surveillance (STEPS) is alsogratefully growing burden of noncommunicable diseases (NCD) represents a major challenge to healthdevelopment.

6 WHO has responded by giving higher priority to NCD prevention, control andsurveillance in its programme of work. surveillance involves ongoing collection of data for betterdecision-making. It underpins public health action and health promotion WHO step wise approach to surveillance (STEPS) is the WHO-recommended framework forNCD surveillance . We are building one common approach to defining core variables for surveys, surveillance and monitoring instruments. The goal is to achieve data comparability over time andbetween countries. STEPS offers an entry point for low and middle income countries to get started inNCD prevention and control activities. It is a simplified approach providing standardized materialsand methods as part of technical collaboration with countries, especially those that lack is surveillance data that unites all our programmes.

7 Some countries need data to assess current levelsof risk, and others to assess the effectiveness of policies and strategies. The STEPS framework isWHO s contribution to building sustainable surveillance systems which improve national capacity andprovide the information necessary for assessing NCD prevention and control activities. This approachwill lead to better integration of NCD policy and programme often countries take second steps too early. step 1 involves obtaining core questionnaire-baseddata on those risk factors that have a major impact on health and are most amenable to step 1 is in place, countries can build upon it: more complex data can be added sequentially asresources allow. STEPS implementation at the country level is strategic, co-ordinated, builds capacityand is have been many revisions of the document following extensive discussions at regional andnational meetings and workshops.

8 We expect this process to continue during the implementation phaseand expect the document to evolve over time. In the meanwhile, WHO will foster and encourageparticipation in the growing network of countries attempting to put in place systems now forunderstanding the changing profile of risk parallel activities accompany the development of the STEPS programme. As comparable coredata become available, countries will have the option to add these to the WHO Global NCD InfoBase,a risk factor database with country specific information. The purpose is to make standardized NCDsurveillance information available on one Internet site. A related project is a global report on thecurrent status of country NCD surveillance systems and , this document is a contribution to building sustainable surveillance systems, which improvenational capacity and provide the information necessary for NCD prevention and control.

9 Futureinitiatives will improve country-level data on noncommunicable disease endpoints, including the useof rapid assessment procedures to describe national NCD surveillance capacity and Catherine Le Gal s- Camus Dr Ruth BonitaAssistant Director-GeneralDirector, SurveillanceNoncommunicable Diseases and Mental HealthWorld Health OrganizationWHO step wise approach to NCD surveillanceviSummaryNoncommunicable diseases (NCD) are responsible for a high proportion of the death and disabilityburden in all countries. In developing countries the burden of disease caused by NCD is increasingrapidly and will have significant social, economic, and health on current trends, by the year 2020 noncommunicable diseases are expected to account for 73%of deaths and 60% of the global disease burden.

10 Most of this increase will result from theepidemiological transition in developing countries, although the burden of NCDs in developedcountries also continues to increase key to control of the global epidemics of NCDs is primary prevention. The aim must be to avertthese epidemics wherever possible and to control them as quickly as possible where they areentrenched. surveillance is fundamental to this of NCDs and their risk factors is an essential element in planning and evaluatingprograms. In a world of finite resources, the priority is to collect data necessary for informing theseprograms, monitoring their impact and predicting the future caseload of NCDs. While data on majorrisk factors for NCDs are available in many developed countries, these data are scarce for manydeveloping countries.