NCD-Strategy 2013–2017

Objectives

Norway’s National Control Plan for non-communicable diseases provides a common strategic framework for preventing, diagnosing, treating and rehabilitating cardiovascular disease, diabetes, chronic obstructive pulmonary disease and cancer. Its central outcome goal is to reduce premature deaths from these four diseases by 25 per cent by 2025, while limiting disease progression, complications and suffering and enabling people to live longer, healthier lives.[1][2]

• Reduce common risk factors, particularly tobacco use, unhealthy diet, overweight and obesity, physical inactivity and harmful alcohol consumption, while addressing social determinants and inequalities in health.[1][3][4]
• Strengthen primary prevention, early diagnosis, secondary prevention, treatment, rehabilitation and systematic follow-up across the disease course.[1][2]
• Identify people at elevated risk and reduce undiagnosed disease through case-finding, appropriate health checks, screening and earlier intervention.[5][6][7]
• Promote healthy lifestyles and supportive environments throughout the population, with particular attention to children and young people, socially disadvantaged groups, some immigrant groups and people with mental disorders.[3][4][5]
• Increase user and patient participation by treating patients as equal partners in care, supporting self-management, and involving patients and families in treatment, follow-up and service improvement.[2][7][8]
• Improve coordinated and equitable services for people with one or more chronic conditions, rather than relying solely on disease-specific treatment.[9][5]
• Advance disease-specific priorities for diabetes, chronic obstructive pulmonary disease and cancer, including prevention, earlier identification, guideline-based treatment, rehabilitation and quality of life for patients and families.[10][11][12][13]

Implementation

The plan combines population-wide prevention, targeted action for people at higher risk, and coordinated health and care services. It builds on existing legislation, national strategies, action plans and clinical guidelines, and links national policy with municipal delivery, specialist services, voluntary organisations and international collaboration.[14][1][3][15]

• Implement health promotion across sectors and settings, recognising that education, employment, housing, income, social support, transport and local environments influence health alongside health and care services.[14][16]
• Support municipalities in their statutory public-health role through local public-health profiles, networks, collaboration with voluntary organisations, regulation, legislation and measures that make healthy choices easier.[14][16]
• Deliver prevention through tobacco control, healthier diets, salt reduction, physical-activity promotion, active transport, school and kindergarten initiatives, and alcohol-control measures including licensing, advertising restrictions, age limits, the Vinmonopolet wholesale monopoly and excise duties.[16][17][9]
• Develop common and disease-specific national guidelines covering prevention, diagnosis, treatment and rehabilitation, with implementation plans and assessment of financial and administrative implications.[5][6]
• Integrate primary and specialist services through patient pathways, statutory agreements between municipalities and health trusts, decision-support tools, shared patient records, welfare technology and mutual competence exchange.[9][18][8]
• Use multidisciplinary and proactive care models, including possible adaptation of the Chronic Care Model, in which general practitioners coordinate teams and other qualified personnel contribute education, exercise support and motivational interviewing.[7][18]
• Expand local support for learning, coping, rehabilitation, exercise, palliative care, patient and family education, healthy lifestyle centres and accessible self-care services.[9][18][19]
• Apply targeted disease measures, including diabetes registers and local follow-up pilots, chronic obstructive pulmonary disease case-finding and lung-function measurement, and cancer pathways, diagnostic centres, multidisciplinary teams and strengthened diagnostic capacity.[10][11][12][13][20]
• Provide political and administrative follow-up through the public health policy council chaired by the Minister of Health and Care Services, while the Directorate of Health monitors whether chronic-disease patient pathways demonstrate success under the Coordination Reform.[16][5]
• Use comparable statistics, health and quality registers, quality indicators, patient experience and guideline implementation to support quality improvement; the source does not specify a single comprehensive reporting timetable or evaluation framework for the full plan.[2][8][10][20]
• Implement the strategy within current budgets, while using health-policy excise duties and specified municipal and voluntary-sector subsidies where relevant; the source does not provide a total implementation budget or detailed funding allocations.[1][16][9]

Monitoring & Evaluation

Monitoring and evaluation combine a headline mortality goal, risk-factor targets, disease registers, quality indicators, screening oversight and political follow-up. The overarching outcome target is to reduce premature deaths from cardiovascular disease, diabetes, chronic lung disease and cancer by 25 per cent by 2025.[1][2]

• Track international risk-factor targets for 2025, including reductions in high blood pressure, tobacco use, salt consumption and physical inactivity.[3]
• Use contextual population measures, including daily smoking prevalence, physical-activity participation and registered alcohol consumption, alongside evidence on diet, obesity, children’s activity, health inequalities and higher-risk groups.[3][4]
• Monitor tobacco-control outcomes through targets for daily smoking, smokeless-tobacco use, smoking among young adults and in late pregnancy, and children’s exposure to passive smoking.[2][16][17]
• Develop internationally comparable statistics to assess changes over time and compare performance across countries.[2]
• Provide political follow-up through the public health policy council, chaired by the Minister of Health and Care Services, which is to follow up the Public health report and the non-communicable disease strategy.[16]
• Assign the Directorate of Health responsibility for monitoring whether good patient pathways for people with chronic disease demonstrate success under the Coordination Reform.[5]
• Use screening and case-finding to identify people at high risk or with early disease, subject to requirements for clinically satisfactory and reliable methods, low risk of adverse effects, high participation and available treatment.[6]
• Monitor commercial health-test offers and establish arrangements to address services that fail to meet satisfactory clinical standards.[7]
• Use standardised annual check-up forms based on information and communications technology to support follow-up and generate quality indicators for national quality registers and primary health services.[18]
• Use the national cardiovascular register to record the sequence and timing of care, make better use of health and quality registers, and develop additional quality indicators.[8]
• Develop diabetes quality indicators, improve reporting to the National Diabetes Register and NOKLUS, and improve fulfilment of guideline-based targets for blood sugar, blood pressure and cholesterol.[10]
• Consider quality indicators, a national chronic obstructive pulmonary disease register in general practice, regional action plans and user surveys for chronic obstructive pulmonary disease care.[12]
• Set a cancer-service objective for 80 per cent of patients to start treatment within 20 days, while using patient experience and patient involvement to improve service quality, guidelines, research and innovation.[13]
• Establish cancer-hospital quality requirements, introduce quality indicators, consider further quality registers, use existing registers to assess adherence to treatment programmes, and review cancer surgery by the end of 2014.[20]
• Monitor participation in human papillomavirus vaccination and establish national governance for screening programmes.[20]

The available material does not set out a single consolidated monitoring architecture, common reporting timetable, comprehensive evaluation methodology or full accountability framework. Several sections instead identify discrete targets, registers, guideline implementation, screening mechanisms and quality-improvement activities.[3][5][7][8][10][20]

Costing & Financing

Financing information is limited. Implementation of the overall strategy is intended to occur within current budgets, although the four target diseases are described as accounting for a significant share of health expenditure and wider societal health and care costs.[1]

• Maintain high tobacco excise duties and consider future changes to health-policy excise duties where they could improve public health.[16]
• Use high alcohol excise duties alongside licensing, the Vinmonopolet wholesale monopoly, advertising restrictions and age limits as part of alcohol policy.[17][9]
• Provide subsidy arrangements for municipalities and voluntary organisations, without specifying allocations or expenditure amounts.[17][9]
• Provide financial facilitation for child health clinics and school health services, and assign municipalities additional resources alongside expanded responsibilities.[5]
• Assess the financial and administrative consequences of national guidelines and implement them within available resources.[5][6]
• Apply financial incentives under the Health and Care Services Act, including municipal co-financing, while leaving the monetary scale and detailed financing model unspecified.[7]
• Recognise education, competence development, rehabilitation, service expansion, information and communications technology, welfare technology and local-authority immediate-assistance services as resource-relevant areas without itemised costing.[7][18]
• Record diabetes-related health costs at approximately 4.1 billion Norwegian kroner in 2011.[19]
• Identify cancer-service resource needs for specialist education and recruitment, diagnostic and radiotherapy capacity, equipment, particle therapy and new treatment methods, without giving explicit budgets or funding sources.[20][21]
• Recognise that cancer care is becoming more interdisciplinary, advanced and costly, and that growing incidence and longer survival will increase capacity and competence demands on hospitals and municipal health and care services.[13]

No quantified implementation budget, comprehensive financing plan, resource-mobilisation strategy, funding-gap assessment or economic assumptions are specified for most disease-specific measures.[3][10][20]