NCD Data Portal Indicators
    Definition:
    Age-standardized death rate (per 100 000 population) for noncommunicable diseases.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Global Monitoring Framework (GMF) or SDG target values for relevant NCD indicators calculated using the relevant comparable estimate value and target % for each indicator. For example, for blood pressure (hypertension) the baseline value is 2010 and the GMF target for 2025 is a 25% relative reduction from this baseline value.
    Estimation method:
    Official WHO comparable estimates (as presented in the NCD data portal, the Global Health Observatory, etc.) are used as baseline values for the targets.
    Definition:
    Country has a vital registration system that captures deaths and the causes of death routinely. The International Form of Medical Certificate of the Cause of Death is completed by certifiers. The International Classification of Diseases (ICD) is used to code the causes of death. The data compiled are made available to policy-makers and researchers. This is the second indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    The WHO collects mortality data, including cause of death, from civil registration systems in the WHO mortality database through a routine annual call for data. Data are considered to generate reliable cause-specific mortality data on a routine basis if: • Data from the five most recent reporting years are, on average, at least 70% usable. Usability is calculated as: (Completeness (%))*(1- Proportion Garbage) • At least five years of cause-of-death data have been reported to the WHO in the last 10 years. • The most recent year of data reported to the WHO is no more than five years old. This indicator is considered fully achieved if the country meets all of the above criteria. This indicator is considered partially achieved if the country does not meet all of the above criteria but has submitted some vital registration data to WHO.
    Definition:
    Country has completed a STEPS survey or another risk factor survey which includes physical measurements and biochemical assessments covering the key behavioural and metabolic risk factors for NCDs. Country must indicate that survey frequency is at least every 5 years. This is the third indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if the country responds “Yes” to each of the following for adults: “Have surveys of risk factors (may be a single RF or multiple) been conducted in your country for all of the following:” “Harmful alcohol use” (optional for the Member States where there is a ban on alcohol), “Physical inactivity”, “Tobacco use”, “Raised blood glucose/diabetes”, “Raised blood pressure/hypertension”, “Overweight and obesity”, and “Salt / Sodium intake”. For risk factors “Raised blood glucose/diabetes”, “Raised blood pressure/hypertension”, and “Overweight and obesity”, the data must be measured, not self-reported. Additionally, for each risk factor, the country must indicate that the last survey was conducted in the past 5 years (i.e. 2016 or later for the 2021 CCS survey responses) and must respond “Every 1 to 2 years” or “Every 3 to 5 years” to the subquestion “How often is the survey conducted?”. The country must also provide the needed supporting documentation. This indicator is considered partially achieved if the country responds that at least 3, but not all, of the above risk factors are covered, or the surveys were conducted more than 5 years ago but less than 10 years ago.
    Definition:
    Country has a multisectoral, national integrated NCD and risk factor policy/strategy/action plan that addresses the 4 main NCDs (cardiovascular diseases, diabetes, cancer, chronic respiratory disease) and their main risk factors (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol). “Multisectoral” refers to engagement with one or more government sectors outside of health. “Operational” refers to a policy, strategy or action plan which is being used and implemented in the country, and has resources and funding available to implement it. This is the fourth indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if the country responds “Yes” to the questions “Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors?” and to the subquestion “ Is it multisectoral?”. Countries also have to respond “operational” to the subquestion “Indicate its stage” and “Yes” to all of the subquestions pertaining to the 4 main risk factors and 4 main NCDs: “Does it address one or more of the following major risk factors?” “Harmful use of alcohol” (optional for the Member States where there is a ban on alcohol), “Unhealthy diet”, “Physical inactivity”, “tobacco” (all 4 must have “Yes”) and “Does it combine early detection, treatment and care for:” “Cancer”, “Cardiovascular diseases”, “ Chronic respiratory diseases” and “Diabetes” (all 4 must have “Yes”). Country must also provide the needed supporting documentation. This indicator is considered partially achieved if the country responds “Yes” to the questions “Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors?” and to the subquestion “ Is it multisectoral?”. Countries also have to respond “operational” to the subquestion “Indicate its stage” and “Yes” to at least two of the 4 main risk factors and at least two of the 4 main NCDs.
    Definition:
    Government approved evidence-based national guidelines/protocols/ standards for the management (diagnosis and treatment) of the four main NCDs – cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. This is the ninth indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is based on the number of countries who indicate that national guidelines/protocols/standards exist for all four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases). This indicator is considered fully achieved if national guidelines/protocols/standards exist for all four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases), and the country provides the needed supporting documentation. This indicator is considered partially achieved if the country has guidelines/protocols/standards for at least two of the four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases), but not for all four.
    Definition:
    Country has provision of drug therapy (including glycaemic control for diabetes mellitus and control of hypertension using a total risk approach), and counselling to individuals who have had a heart attack or stroke and to persons with high risk (≥ 30%, or ≥20%) of a fatal and non-fatal cardiovascular event in the next 10 years. This is the 10th indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is based on the number of countries who respond “more than 50%” to the question “What proportion of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke?”. Additionally, countries must have said all the following drugs were “generally available” in the primary care facilities of the public health sector: insulin, aspirin, metformin, thiazide diuretics, ACE inhibitors or Angiotensin II receptor blockers (at least one of the two), CC blockers, statins, and sulphonylurea(s). This indicator is considered fully achieved if the country reports that more than 50% of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke and that all drugs listed above were generally available in the primary care facilities of the public health sector. This indicator is considered partially achieved if the country reports that between 25% to 50% of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke and that all of the drugs listed above were generally available in the primary care facilities of the public health sector.
    Definition:
    Indicates whether country has set national NCD targets. The NCD-related targets should be time-bound and based on the 9 voluntary global targets and the WHO Global Monitoring Framework. This is the first indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if a country responds “Yes” to the question “Are there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs?” and provides the needed supporting documentation. Targets must be time-bound, based on the 9 global targets, and need to address NCD mortality, as well as key risk factors in the country and/or health systems. This indicator is considered partially achieved if the country responds “Yes” to the question “Are there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs?”, but the targets do not cover two of the three areas addressed in the 9 global targets (including mortality) or they are not time-bound.
    Definition:
    Percentage of total deaths due to NCDs overall and percentage of total deaths due to: 1) cardiovascular diseases, 2) cancer 3) chronic respiratory diseases, 4) diabetes (including deaths from chronic kidney disease due to diabetes), 5) other NCDs, 6) injuries and 7) communicable, maternal, perinatal and nutritional conditions.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Deaths due to noncommunicable diseases (NCDs) among people aged below 70 years, as a percentage of NCD deaths among all ages.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Percentage of 30-year-old-people who would die before their 70th birthday from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases, assuming that s/he would experience current mortality rates at every age and s/he would not die from any other cause of death (e.g. injuries or HIV/AIDS).
    Estimation method:
    Probability of death between exact age 30 and exact age 70 was calculated using cause-specific mortality rates in each 5-year age group and standard life table methods. The estimates are derived from the WHO Global Health Estimates (GHE) (https://www.who.int/data/global-health-estimates).
    Definition:
    Projections of NCD mortality and risk factor indicators with time-series data for estimating future country attainment of targets.
    Estimation method:
    Projections were generated based on the methods used for the projections of the WHO Global Programme of Work (GPW13) indicators. For glucose, mortality, alcohol and salt projections, eight models were considered: random walk with trend (RW2), autoregressive (AR1), exponential smoothing, Holt’s linear trend, Holt’s linear trend (damped), flat extrapolation, linear extrapolation and annual average rate change extrapolation. As described in further detail in the GPW13 methodology document, models were tested using existing data, with part of these serving as test data. To determine which model performed best, the following statistical metrics were used: RMSE (root mean squared error), MAE (mean absolute error), MdAE (median absolute error), MASE (median absolute scaled error) and CBA (confidence bound accuracy: percentage of test points that lie within the predicted confidence intervals). Using all of these metrics, the best model was selected independently for each indicator and then used to project data to 2025 or 2030. For tobacco use, a Bayesian negative binomial meta-regression was used to fit trendlines and project to 2025. Projections are predominantly based on data from before the COVID-19 pandemic and are not adjusted for any possible impact on trends the pandemic may have had. Adult prevalence of obesity, prevalence of insufficient activity were projected assuming trends since 2010 continue. To do so, a regression was fit for each Bayesian model iteration, country and sex, with the probit of age-standardized prevalence as the dependent variable, and year as the independent variable. The regression was used to predict age-standardized prevalence for each model iteration, country, sex and projection year. The projected values shown are the mean of all Bayesian iterations for the country, sex and projection year. For obesity, on-track status was assessed based on the proportion of iterations for which the regression coefficient was less than or equal to zero, which is the posterior probability that the trend in age-standardized prevalence was flat or decreasing. Each country-sex was considered on track if the posterior probability of a flat or decreasing trend was greater than 0.5. For insufficient physical activity, each sex and country were considered on-track if the projected value for 2030 was less than 85% of the estimated value for 2010. For both obesity and insufficient physical activity, countries were further categorized by the likelihood that past trends were sufficient to meet the target. Raised blood pressure was projecting using a similar method, with the exception that regressions were fit for each country and sex.
    Definition:
    Number of deaths due to all noncommunicable diseases.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Age-standardized mortality rate (per 100 000 population) attributed to ambient air pollution.
    Estimation method:
    Burden of disease is calculated by first combining information on the increased (or relative) risk of a disease resulting from exposure, with information on how widespread the exposure is in the population (in this case, the annual mean concentration of particulate matter to which the population is exposed). This allows calculation of the 'population attributable fraction' (PAF), which is the fraction of disease seen in a given population that can be attributed to the exposure, in this case the annual mean concentration of particulate matter. Applying this fraction to the total burden of disease (e.g. cardiopulmonary disease expressed as deaths or DALYs), gives the total number of deaths or DALYs that results from ambient air pollution.
    Definition:
    Age-standardized mortality rate (per 100 000 population) attributed to household air pollution.
    Estimation method:
    Burden of disease is calculated by first combining information on the increased (or relative) risk of a disease resulting from exposure, with information on how widespread the exposure is in the population (in this case, the percentage of people using polluting fuels). This allows calculation of the 'population attributable fraction' (PAF), which is the fraction of disease seen in a given population that can be attributed to the exposure, in this case polluting fuel use. Applying this fraction to the total burden of disease (e.g. due to child pneumonia expressed as deaths or DALYs), gives the total number of deaths or DALYs that results from household air pollution due to the use of polluting fuels.
    Definition:
    Age-standardized mortality rate (per 100 000 population) attributed to household and ambient air pollution.
    Estimation method:
    Burden of disease is calculated by first combining information on the increased (or relative) risk of a disease resulting from exposure, with information on how widespread the exposure is in the population. This allows calculation of the 'population attributable fraction' (PAF), which is the fraction of disease seen in a given population that can be attributed to the exposure. For the case of the joint exposure of both ambient and household air pollution, the PAF is calculated separately for ambient and household, and then combined with a mathematical formula. Applying this fraction to the total burden of disease (e.g. cardiopulmonary disease expressed as deaths), gives the total number of deaths or that results from the joint effects of ambient and household air pollution.
    Definition:
    The country has established ambient air quality standards for 8-hour O3.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    The country has established ambient air quality standards for annual NO2.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    The country has established ambient air quality standards for annual PM10.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    The country has established ambient air quality standards for annual PM2.5.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan to provide access to clean fuels and technologies. This could be either an energy policy, strategy or action plan or the inclusion of household energy in an integrated NCD policy, strategy or action plan.
    Estimation method:
    The WHO Household energy policy repository (https://www.who.int/tools/household-energy-policy-repository) was used to determine whether or not relevant policies exist. A "yes" indicates that the country has a policy in the repository, a "no" indicates that it does not.
    Definition:
    The country is a party to one of the following treaties relating to transboundary air pollution : 1) the UNECE Convention on Long Range Transboundary Air Pollution (CLRTAP), or 2) the ASEAN Agreement on Transboundary Haze Pollution (Haze agreement), or 3) the Malé Declaration on Control and Prevention of Air Pollution and its likely transboundary effects for South Asia.
    Estimation method:
    The official and most up to date list of parties for each treaty are available at the following sites: CLRTAP : https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=XXVII-1&chapter=27&clang=_en#2 ASEAN agreement on Transboundary Haze Pollution : https://asean.org/media-release-seventeenth-meeting-of-the-conference-of-the-parties-to-the-asean-agreement-on-transboundary-haze-pollution-cop-17/ Malé Declaration on Control and Prevention of Air Pollution : http://www.sacep.org/programmes/male-declaration
    Definition:
    If the national standard is equal to or below the WHO Air Quality Guidelines (AQG), it is fully achieved; if it is between AQG and the highest interim target (IT), it is partially achieved and if it is above the highest IT, it is not achieved.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    If the national standard is equal to or below the WHO Air Quality Guidelines (AQG), it is fully achieved; if it is between AQG and the highest interim target (IT), it is partially achieved and if it is above the highest IT, it is not achieved.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    If the national standard is equal to or below the WHO Air Quality Guidelines (AQG), it is fully achieved; if it is between AQG and the highest interim target (IT), it is partially achieved and if it is above the highest IT, it is not achieved.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    If the national standard is equal to or below the WHO Air Quality Guidelines (AQG), it is fully achieved; if it is between AQG and the highest interim target (IT), it is partially achieved and if it is above the highest IT, it is not achieved.
    Estimation method:
    Data is regularly compiled by WHO in collaboration with the Swiss Tropical and Public Health Institute and by UNEP: https://www.who.int/tools/air-quality-standards https://www.unep.org/resources/report/regulating-air-quality-first-global-assessment-air-pollution-legislation Please also see: Kultar et al. 2017 https://link.springer.com/article/10.1007/s00038-017-0952-y
    Definition:
    Age-standardized death rate (per 100 000 population) for cancer.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of cancer through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that there is a national screening programme targeting the general population for cervical cancer.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that there is a national screening programme targeting the general population for breast cancer.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for cancer. This could be either a cancer-specific policy, strategy or action plan (on one or more cancers specifically or cancer in general) or the inclusion of cancer in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a population-based cancer registry.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that cancer centres or cancer departments at tertiary level are generally available in the public sector. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that cancer surgery is generally available in the public sector. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that chemotherapy is generally available in the public sector. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that community- or home-based palliative care is generally available for patients with NCD in the public health system. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that palliative care is generally available for patients with NCD in primary health care facilities within the public health system. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that pathology services (laboratories) are generally available in the public sector. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that radiotherapy is generally available in the public sector. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Number of deaths due to cancer
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Estimated percent of new cases of cancer, by site, out of all cancers (all ages)
    Estimation method:
    Estimates were calculated by the International Agency for Research on Cancer (IARC). Details of their methods are available here: https://gco.iarc.fr/today/data-sources-methods
    Definition:
    Estimated percent of deaths by site, out of all cancer deaths
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Deaths due to cancer among people aged below 70 years, as a percentage of cancer deaths among all ages.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Percentage of women aged 30–49 years screened for cervical cancer in their lifetime.
    Estimation method:
    National official recommendations for cervical cancer screening as well as screening coverage data from survey data and official administrative estimates were used to calculate the screening coverage estimates. The full details of the estimation process are available here: Bruni L et al. Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. Lancet Glob Health 2022; 10: e1115–27.
    Definition:
    Percentage of women aged 30–49 years screened for cervical cancer in the last 5 years.
    Estimation method:
    National official recommendations for cervical cancer screening as well as screening coverage data from survey data and official administrative estimates were used to calculate the screening coverage estimates. The full details of the estimation process are available here: Bruni L et al. Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. Lancet Glob Health 2022; 10: e1115–27.
    Definition:
    These data represent the amount of opioids reported to the International Narcotics Control Board (INCB) as having been distributed legally in a country for medical use to health care institutions and programmes that are licensed to dispense to patients (i.e. hospitals, nursing homes, pharmacies, hospice and palliative care programmes). Opioids included were morphine, fentanyl, hydromorphone, codeine, oxycodone and pethidine.
    Estimation method:
    Data were obtained from the International Narcotics Control Board (INCB), which provides the data in kilograms (kg) per country. The oral morphine equivalence, ME metric, (also referred to as DOME by the Lancet Commission) was then calculated using internationally accepted and approved conversion values developed by the WHO Collaborating Centre for Data Statistics and Methodology in Oslo, Norway and converted to milligrams (mg) per person based on population data for the same year (i.e. 2017) obtained from the United Nations Population Division estimates (1) and cross-referenced with World Bank population data in order to calculate per capita consumption. The ME metric was calculated for the countries with values reported to the INCB for at least one or more of the included medicines. There are several countries who reported extremely low amounts and appear as <1. Some other countries actually reported “zero” (0) and appear as such. These values are to be distinguished from countries who did not report data to the INCB for any of the included opioids and these are signified as “no data". It is possible that actual opioid consumption may have been higher or lower as countries may report updated data in subsequent year(s).
    Definition:
    Age-standardized death rate (per 100 000 population) for cardiovascular diseases.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of cardiovascular diseases through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for cardiovascular diseases (CVDs). This could be either a CVD-specific policy, strategy or action plan or the inclusion of CVDs in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that ACE inhibitors are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that Angiotensin II receptor blockers (ARBs) are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that beta blockers are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country reported that blood pressure measurement is generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that CC blockers are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that the fixed dose combination (lisinopril + amlodipine) is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that the fixed dose combination (lisinopril + hydrochlorothiazide) is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that the fixed dose combination (telmisartan + amlodipine) is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that the fixed dose combination (telmisartan + hydrochlorothiazide) is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that statins are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that thiazide diuretics are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that total cholesterol measurement is generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering raised blood pressure.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering raised total cholesterol.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Mean total cholesterol of defined population in mmol/l.
    Estimation method:
    Full details of input and data methods are available in: NCD Risk Factor Collaboration (NCD-RisC). Repositioning of the global epicentre of non-optimal cholesterol. Nature 582, 73–77 (2020). A total of 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older were used to estimate mean total trends of HDL and non-HDL cholesterol from 1980 to 2018. Most studies in the analysis measured total cholesterol and HDL cholesterol, from which non-HDL cholesterol can be calculated through subtraction. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Deaths due to cardiovascular diseases among people aged below 70 years, as a percentage of cardiovascular disease deaths among all ages.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Prevalence of controlled hypertension among adults aged 30–79 with hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension).
    Estimation method:
    Full details of input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1,201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Prevalence of hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension) among adults aged 30–79.
    Estimation method:
    Full details of input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1,201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Prevalence of previous diagnosis of hypertension among adults aged 30–79 with hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension).
    Estimation method:
    Full details of input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1,201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Percentage of adults aged 30–79 years with raised blood pressure (systolic blood pressure ≥ 140 mmHg OR diastolic blood pressure ≥ 90 mmHg).
    Estimation method:
    Full details of input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1,201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Prevalence of treatment (taking medicine) for hypertension among adults aged 30–79 with hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension).
    Estimation method:
    Full details of input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1,201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Prevalence of uncontrolled hypertension among adults aged 30–79 years with hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension).
    Estimation method:
    Calculated by subtracting the age-standardized estimate for controlled hypertension from the age-standardized estimate for treatment (taking medicine) for hypertension. For details of the original estimates of diagnosis and control, input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019.
    Definition:
    Prevalence of undiagnosed hypertension among adults aged 30–79 with hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension).
    Estimation method:
    Calculated by subtracting the age-standardized estimate for previous diagnosis of hypertension from 100. For details of the original estimate of previous diagnosis of hypertension, the input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019.
    Definition:
    Prevalence of untreated hypertension (not taking medicine) among adults aged 30–79 with hypertension (defined as having systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or taking medication for hypertension).
    Estimation method:
    Calculated by subtracting the age-standardized estimate for treatment (taking medicine) for hypertension from the age-standardized estimate for previous diagnosis of hypertension. For details of the original estimates of diagnosis and treatment, input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet S0140-6736(21)01330-1. A total of 1,201 population-based studies that included measured blood pressure and data on blood pressure treatment in 104 million individuals aged 30–79 years were used to estimate trends in hypertension and hypertension diagnosis, treatment and control from 1990 to 2019.
    Definition:
    Age-standardized death rate (per 100 000 population) for chronic respiratory diseases.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Exceedance of the WHO guideline level for annual mean concentration of particles of ≤ 2.5 micrometres in the air is derived by dividing the annual mean concentration of fine particulate matter (particles with diameters ≤ 2.5 micrometers) (PM2.5) in a country by the recommended annual mean concentration level of PM2.5 found in WHO Air Quality Guidelines (5 ug/m3).
    Estimation method:
    The indicator of exposure to ambient (outdoor) air pollution was estimated by dividing the annual mean concentration of fine particulate matter (particles with diameters ≤ 2.5 micrometers) (PM2.5) in a country by the recommended annual mean concentration level of PM2.5 found in WHO Air Quality Guidelines (5 ug/m3). Country-level estimates of PM2.5 were derived using a mathematical model that used ground-level measurements of PM compiled in the WHO ambient air quality database, data from satellite remote sensing, and other demographic data. Note : WHO released an updated version of the WHO Air Quality Guidelines (AQG) in 2021, in which the recommended annual mean concentration level of PM2.5 has been halved compared to the one in the previous version (2005) of the WHO AQG. The new value is now 5 ug/m3 instead of 10 ug/m3, with the latter now labeled interim target 4. The indicator featured in the 2018 NCD country profiles can hence not be directly compared with the current one (or they should be doubled). References: WHO global air quality guidelines. Particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/345329) WHO air quality database, 2022 update: https://www.who.int/data/gho/data/themes/air-pollution/who-air-quality-database Shaddick G, Thomas ML, Green A, Brauer M, van Donkelaar A, Burnett R et al. Data integration model for air quality: a hierarchical approach to the global estimation of exposures to ambient air pollution. Appl Statist. 2018;67(1):231–53 (https://pubs.acs.org/doi/10.1021/acs.est.8b02864).
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of chronic respiratory diseases through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for chronic respiratory diseases (CRDs). This could be either a CRD-specific policy, strategy or action plan or the inclusion of CRDs in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that bronchodilator inhalers are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that combination budesonide-formoterol inhalers are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that peak flow measurement is generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that spirometry is generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that steroid inhalers are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Number of deaths due to asthma
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Number of deaths due to chronic respiratory diseases
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Deaths due to asthma among people aged below 30 years, as a percentage of cardiovascular disease deaths among all ages.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Deaths due to asthma among people aged below 70 years, as a percentage of cardiovascular disease deaths among all ages.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Deaths due to chronic respiratory diseases among people aged below 70 years, as a percentage of chronic respiratory disease deaths among all ages.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    The percentage of the population that relies on polluting fuels and technologies as the primary source of domestic energy for cooking.
    Estimation method:
    The indicator is calculated as the number of people using polluting fuels and technologies divided by total population, expressed as a percentage. Based on the recommendations included in the WHO Guidelines for indoor air quality: household fuel combustion, the fuels and technologies that are considered polluting include biomass, coal, kerosene, gasoline, diesel, rubber and trash. A non parametrical statistical model based on household survey data and time as inputs is applied to derive estimates. For further information on the model, see Stoner O, Shaddick G, Economou T, Gumy S, Lewis J, Lucio I, Ruggeri G, Adair-Rohani H. (2020) Global Household Energy Model: A Multivariate Hierarchical Approach to Estimating Trends in the Use of Polluting and Clean Fuels for Cooking, Journal of the Royal Statistical Society Series C: Applied Statistics, DOI:10.1111/rssc.12428 (https://rss.onlinelibrary.wiley.com/doi/full/10.1111/rssc.12428) Input data for the model is found in the WHO Household Energy Database. This database compiles data from nationally-representative surveys and censuses that provide estimates of primary cooking fuels and technologies. In cases where estimates of the population not cooking at home, with missing data or cooking with "other" fuels are provided, these populations are removed from the denominator for estimation purposes.
    Definition:
    Age-standardized death rate (per 100 000 population) for diabetes, including deaths from chronic kidney disease due to diabetes.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Indicates whether or not the country has a diabetes registry.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has set a national target addressing diabetes.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of diabetes through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for diabetes. This could be either a diabetes-specific policy, strategy or action plan or the inclusion of diabetes in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that either blood glucose measurement or oral glucose tolerance test (OGTT) or both are generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that diabetic retinopathy screening is generally available in the publicly funded health system. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that dialysis is generally available in the publicly funded health system. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that dilated fundus examinations are generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that foot vibration perception by tuning fork is generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that insulin is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that metformin is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that renal transplantation is generally available in the public sector. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that retinal photocoagulation is generally available in the publicly funded health system. "Generally available" is defined as reaching 50% or more patients in need.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that sulphonylureas are generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that urine strips for glucose and ketone measurement are generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that urine strips for albumin assay are generally available at the primary health care level, either in the private or public sector or both. "Generally available" is defined as "in 50% or more health care facilities."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering raised blood glucose/diabetes.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Number of deaths due to diabetes, including deaths due to chronic kidney disease due to diabetes.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Deaths due to diabetes among people aged below 70 years, as a percentage of diabetes deaths among all ages. Diabetes deaths include deaths from chronic kidney disease due to diabetes.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Percentage of adults aged 18+ years with fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl) or glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol), or on glucose-lowering medication for diabetes.
    Estimation method:
    Population-representative studies with measurements of fasting glucose and/or glycated haemoglobin (HbA1c), and information on diabetes treatment were compiled. In studies with data on both FPG and HbA1c, treated diabetes was added to the prevalence of untreated diabetes based on the definition above. In studies with data on one biomarker only, participants whose measured biomarker was elevated were considered to have diabetes. For the remainder of the sample, who neither used treatment nor had elevated level of the measured biomarker, regressions were used to estimate the probability of having an elevated level of the second (unmeasured) biomarker. Data were pooled using a Bayesian hierarchical meta-regression model to estimate diabetes prevalence. Age-standardized estimates are produced by applying the age-specific estimates to the WHO Standard Population. Full details of input and data methods are available at: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. Lancet 2024. Available online at: https://doi.org/10.1016/S0140-6736(24)02317-1
    Definition:
    Age-standardized death rate (per 100 000 population) for cirrhosis due to alcohol use.
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Indicates whether or not the country has set a national target addressing the harmful use of alcohol.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of alcohol use disorders through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for alcohol. This could be either an alcohol-specific policy, strategy or action plan or the inclusion of alcohol in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering harmful alcohol use.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Country has regulatory or co-regulatory frameworks for alcohol advertising through different channels (public service/national TV, commercial/private TV, national radio, local radio, print media, billboards, points of sale, cinema, internet, social media). Country has a detection system for infringements on marketing restrictions. This is indicator 6b from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Data is collected through the WHO Global survey on progress on SDG health target 3.5. This indicator is considered fully achieved if: • restrictions exist on alcohol advertising for beer, wine, and spirits through all channels; and • detection system exists for infringements on marketing restrictions. This indicator is considered partially achieved if there are restrictions on at least public service/national TV, national radio and billboards but no detection system exists for infringements.
    Definition:
    Country has a licensing system or monopoly on retail sales of beer, wine, spirits. Country has restrictions for on-/off-premise sales of beer, wine, spirits regarding hours, days and locations of sales. Country has legal age limits for being sold and served alcoholic beverages. This is indicator 6a from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Data is collected through the WHO Global survey on progress on SDG health target 3.5. This indicator is considered fully achieved if: • a licensing system or monopoly exists on retail sales of beer, wine and spirits; • restrictions exist for on- and off-premise sales of beer, wine, and spirits regarding hours and locations of sales and restrictions exist for off-premise sales of beer, wine, and spirits regarding days of sales; and • legal age limits for being sold and served alcoholic beverages are 18 years or above for beer, wine, and spirits. This indicator is considered partially achieved if there are any, but not all, positive responses to the three indicators above.
    Definition:
    Country has excise tax on beer, wine, spirits. Country adjusts level of taxation for inflation for alcoholic beverages. This is indicator 6c from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Data is collected through the WHO Global survey on progress on SDG health target 3.5. This indicator is considered fully achieved if: • excise tax on all alcoholic beverages (beer, wine, and spirits) is implemented; • there are no tax incentives or rebates for production of other alcoholic beverages; and • adjustment of level of taxation for inflation for beer, wine, and spirits is implemented. This indicator is considered partially achieved if there is excise tax on alcoholic beverages as specified above.
    Definition:
    Number of deaths due to alcohol use disorders
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Number of deaths due to cirrhosis due to alcohol use
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Number of deaths due to liver cancer secondary to alcohol use
    Estimation method:
    Source: WHO Global Health Estimates (GHE). Detailed methods are available online (https://cdn.who.int/media/docs/default-source/gho-documents/global-health-estimates/ghe2019_cod_methods.pdf?sfvrsn=37bcfacc_5) and summarized below. For countries with a high-quality vital registration system including information on cause of death, the vital registration that Member States submit to the WHO Mortality Database were used, with adjustments where necessary, e.g. for under-reporting of deaths, unknown age and sex, and ill-defined causes of deaths. For countries without high-quality death registration data, cause of death estimates are calculated using other data, including household surveys with verbal autopsy, sample or sentinel registration systems, special studies. These estimates represent the best estimates of WHO, computed using standard categories, definitions and methods to ensure cross-country comparability, and may not be the same as official national estimates. Due to changes in input data and methods, the revisions of GHE are not comparable to previously published WHO estimates.
    Definition:
    Heavy episodic drinking is defined as the proportion of adults (15+ years) who have had at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days. A consumption of 60 grams of pure alcohol corresponds approximately to 6 standard alcoholic drinks. Numerator: The (appropriately weighted) number of respondents (15+ years) who reported drinking 60 grams or more of pure alcohol on at least one occasion in the past 30 days. Denominator: The total number of participants (15+ years) responding to the corresponding question(s) in the survey plus abstainers.
    Estimation method:
    A representative sample of the adult population (15+ years) of the country is asked to answer questions in a survey. The first priority in the decision tree is given to internationally comparative, nationally representative surveys (in this order of preference: WHS, STEPS, GENACIS, and ECAS); second is national surveys.
    Definition:
    Total APC is defined as the total (sum of three-year average recorded and three-year average unrecorded APC, adjusted for three-year average tourist consumption) amount of alcohol consumed per adult (15+ years) over a calendar year, in litres of pure alcohol. Recorded alcohol consumption refers to official statistics (production, import, export, and sales or taxation data), while the unrecorded alcohol consumption refers to alcohol which is not taxed and is outside the usual system of governmental control. Tourist consumption takes into account tourists visiting the country and inhabitants visiting other countries. Positive figures denote alcohol consumption of outbound tourists being greater than alcohol consumption by inbound tourists, negative numbers the opposite. Tourist consumption is based on UN tourist statistics.
    Estimation method:
    Recorded alcohol per capita (15+) consumption of pure alcohol is calculated as the sum of beverage-specific alcohol consumption of pure alcohol (beer, wine, spirits, other) from different sources: the first priority in the decision tree is given to government statistics; second are country-specific alcohol industry statistics in the public domain based on interviews or field work (GlobalData (formerly Canadean), IWSR-International Wine and Spirit Research, Wine Institute, historically World Drink Trends), or data from the International Organisation of Vine and Wine (OIV); third is the Food and Agriculture Organization of the United Nations' statistical database (FAOSTAT); and fourth is data from alcohol industry statistics in the public domain based on desk review. For countries, where the data source is FAOSTAT the unrecorded consumption may be included in the recorded consumption. As from the introduction of the "Other" beverage-specific category, beer includes malt beers, wine includes wine made from grapes, spirits include all distilled beverages, and other includes one or several other alcoholic beverages, such as fermented beverages made from sorghum, maize, millet, rice, or cider, fruit wine, fortified wine.
    Definition:
    Indicates whether or not the country has set a national target addressing obesity.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of overweight/obesity through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for reducing overweight/obesity.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has implemented price subsidies for healthy foods.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has implemented taxation on foods high in fat, sugars or salt.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has implemented taxation on sugar sweetened beverages.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Country has implemented a policy(ies) to limit saturated fatty acids and virtually eliminate industrially produced trans-fats in the food supply. This is indicator 7b from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if the country responds “Yes” to the questions “Is your country implementing any national policies to reduce population saturated fatty acid intake?” and “Is your country implementing any national policies to eliminate industrially produced trans-fatty acids in the food supply?”, and provides the needed supporting documentation. This indicator is considered partially achieved if the country responds “Yes” to either of the aforementioned questions.
    Definition:
    Country has implemented national policies to reduce population salt/sodium consumption, including reformulation of food products; establishment of a supportive environment in public institutions to enable lower sodium options to be provided; behaviour change communication and mass media campaigns; and front-of-pack labelling. This is indicator 7a from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if the country responds “Yes” to the question “Is your country implementing any policies to reduce population salt consumption?” and to the subquestions “Are these targeted at: product reformulation by industry across the food supply; regulation of salt content of food served in specific settings such as hospitals, schools, workplaces; public awareness programme; front-of-pack nutrition labelling? (must have “Yes” to product reformulation by industry across the food supply and/or regulation of salt content of food, and “Yes” to public awareness programme and nutrition labelling”). Country must also provide the needed supporting documentation. This indicator is considered partially achieved if the country responds “Yes” to the question “Is your country implementing any policies to reduce population salt consumption?”, and “Yes” to at least one of the four subquestions “Are these targeted at: product reformulation by industry across the food supply; regulation of salt content of food served in specific settings such as hospitals, schools, workplaces; public awareness programme; front-of-pack nutrition labelling?”.
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering overweight and obesity.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering salt/sodium intake.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering unhealthy diet.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Country has implemented a policy(ies) to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt. This is indicator 7c from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if the country responds “Yes” to the question “Is your country implementing any policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt?”, and provides the needed supporting documentation.
    Definition:
    Country has implemented legislation/regulations that fully implement the International Code of Marketing of Breast-milk Substitutes. This is indicator 7d from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Copies of all laws and regulations on the International Code of Marketing of Breast-milk Substitutes are compiled by WHO every two years. WHO routinely requests countries to submit copies of Code legislation when they learn of changes. Additionally, copies of legislation were obtained from UNICEF and IBFAN/ICDC and legal databases (Lexis/Nexis and FAO-LEX), EUR-LEX, national gazettes and internet search engines. This indicator is considered fully achieved if the country is assessed as having national legal measures categorized as “substantially aligned with the Code”, whereby countries have enacted legislation or adopted regulations, decrees or other legally binding measures encompassing all or nearly all provisions of the Code and subsequent WHA resolutions. This indicator is considered partially achieved if the country is assessed as having national legal measures categorized as “Moderately aligned with the Code” or having “Some provisions of the Code included”, whereby countries have enacted legislation or adopted regulations, decrees or other legally binding measures encompassing at least some provisions of the Code and subsequent WHA resolutions.
    Definition:
    Indicates whether or not the country has implemented any national public education and awareness campaign on diet within the past 2 years.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Mean daily population salt intake, in grams/day, among adults aged 25+ years.
    Estimation method:
    Estimates for mean population sodium intake were calculated by the Institute for Health Metrics and Evaluation (IHME). More information available on their website: https://www.healthdata.org/results/gbd_summaries/2019/diet-high-sodium-level-3-risk Estimates were converted to salt intake by multiplying by 2.5.
    Definition:
    Percentage of defined age group with a body mass index (BMI) greater than 2 standard deviation above the median, according to the WHO references for school-age children and adolescents.
    Estimation method:
    Based on measured height and weight. Input data and methods are described here: NCD-RisC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2.
    Definition:
    Percentage of adults aged 18+ years with a body mass index (BMI) of 30 kg/m2 or higher.
    Estimation method:
    Based on measured height and weight. Input data and methods are described here: NCD-RisC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Percentage of defined age group with a body mass index (BMI) greater than 2 standard deviation above the median, according to the WHO references for school-age children and adolescents.
    Estimation method:
    Based on measured height and weight. Input data and methods are described here: NCD-RisC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2.
    Definition:
    Percentage of defined age group with a body mass index (BMI) greater than 1 standard deviation above the median, according to the WHO references for school-age children and adolescents.
    Estimation method:
    Based on measured height and weight. Input data and methods are described here: NCD-RisC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2.
    Definition:
    Percentage of adults aged 18+ years with a body mass index (BMI) of 25 kg/m2 or higher.
    Estimation method:
    Based on measured height and weight. Input data and methods are described here: NCD-RisC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2. Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Percentage of defined age group with a body mass index (BMI) greater than 1 standard deviation above the median, according to the WHO references for school-age children and adolescents.
    Estimation method:
    Based on measured height and weight. Input data and methods are described here: NCD-RisC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024. DOI: https://doi.org/10.1016/S0140-6736(23)02750-2.
    Definition:
    Indicates whether or not the country has set a national target addressing physical inactivity.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of physical inactivity through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has national guidelines that provide recommended levels of physical activity for the population or a specific segment of the population.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has national guidelines that provide recommended levels of physical activity for adults.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has national guidelines that provide recommended levels of physical activity for children and adolescents aged 5 to 19 years.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has national guidelines that provide recommended levels of physical activity for children under 5.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has national guidelines that provide recommended levels of physical activity for older adults.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan for to reduce physical activity and/or promote physical activity. This could be either a physical activity-specific policy, strategy or action plan or the inclusion of physical activity in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a national policy promoting active ageing.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a national policy promoting physical activity in childcare settings.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a national policy promoting community-based physical activity and sports initiatives.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a national policy promoting public open spaces (including parks) in order to promote physical activity.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a national policy to promote walking and cycling.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has a national policy promoting workplace physical activity initiatives.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering physical inactivity.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Country has implemented at least one recent (within the past 2 years) national public awareness programme on physical activity. This is the eighth indicator from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs). This indicator is considered fully achieved if the country responds “Yes” to the following question: “Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years?” and supporting documents provide clear evidence demonstrating that one or more of the following activities have been undertaken within the past 2 years: (1) national public-facing mass media education and awareness campaign on physical activity, AND/OR (2) national promotional initiatives supporting a regional or multi-country physical activity (sports) campaigns aimed at increasing awareness and encouraging participation in physical activity (e.g. European Sports Week, Caribbean Wellness Week), AND/OR (3) regular promotional days, held across the year, on physical activity either using the same theme (e.g. “car-free” Sundays) or a physical activity theme is clearly linked with the implementation of multiple health promotion days (e.g. World Heart Day, World Diabetes Day). Undertaking a single promotional day per year is not sufficient to fulfil this criteria. This indicator is considered partially achieved if the supporting documents provide evidence demonstrating that the country has implemented in the past 2 years one or more community-based initiatives or programmes promoting physical activity and/or increasing access to opportunities for physical activity in community settings (e.g. through schools, parks, workplace, health care) but without any evidence of a public-facing mass media education and awareness campaign.
    Definition:
    Indicates whether or not the country has implemented any national or subnational mass participation events to encourage participation by the general public in free opportunities for physical activity within the past 2 years.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Percentage of defined population attaining less than 150 minutes of moderate-intensity physical activity per week, or less than 75 minutes of vigorous-intensity physical activity per week, or equivalent.
    Estimation method:
    A Bayesian hierarchical model was used to produce estimates for each country or territory, age, sex and year. Full details of methods are available in: Strain T, Flaxman SR, Guthold R, Semenova E, et al. National, regional and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 surveys with 5.7 million participants. Lancet Global Health, 2024.. The estimates are based on self-reported physical activity captured using the GPAQ (Global Physical Activity Questionnaire), the IPAQ (International Physical Activity Questionnaire) or a similar questionnaire covering activity at work/in the household, for transport, and during leisure time. Where necessary, adjustments were made for the reported definition (in case it was different to the indicator definition), for known over-reporting of activity in questionnaires such as the IPAQ, and for survey coverage (in case a survey only covered urban areas). Age-standardized estimates are produced by applying the crude estimates to the WHO Standard Population.
    Definition:
    Percentage of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
    Estimation method:
    Full details of methods are available in: Guthold R et al. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants. Lancet Child Adolesc Health. 2020 Jan;4(1):23-35. (https://doi.org/10.1016/S2352-4642(19)30323-2). The estimates are based on self-reported physical activity using questionnaires.  Main data sources included the Global School-based Student Health Survey (GSHS), the Health Behaviour in School aged Children (HBSC), and some other national surveys.  Where necessary, adjustments were made for the reported definition (in case it was different to the indicator definition), and for survey coverage (in case a survey only covered urban areas).  No estimates were produced for countries with no data.
    Definition:
    Indicates whether or not the country has set a national target addressing tobacco use.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has evidence-based national guidelines/protocols/standards for the management of tobacco dependence through a primary care approach recognized/approved by government or competent authorities.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has an operational policy, strategy or action plan to decrease tobacco use. This could be either a tobacco-specific policy, strategy or action plan or the inclusion of tobacco in an integrated NCD policy, strategy or action plan.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has reported that nicotine replacement therapy is generally available in primary health care facilities in the public health sector. "Generally available" is defined as "in 50% or more pharmacies."
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Indicates whether or not the country has conducted a recent (i.e. in the past 5 years), national adult risk factor survey covering tobacco use.
    Estimation method:
    Official country response to the WHO NCD country capacity survey (https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs).
    Definition:
    Country has a ban on all forms of direct and indirect advertising. Direct advertising bans include: national television and radio; local magazines and newspapers; billboards and outdoor advertising; point of sale (indoor). Indirect advertising bans include: free distribution of tobacco products in the mail or through other means; promotional discounts; non-tobacco products identified with tobacco brand names (brand stretching); brand names of non-tobacco products used for tobacco products (brand sharing); appearance of tobacco brands (product placement) or tobacco products in television and/or films; and sponsorship (contributions and/or publicity of contributions). This is indicator 5d from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Legislation is assessed to determine whether the law completely bans all forms of direct and indirect tobacco advertising, promotion and sponsorship. This indicator is considered fully achieved if the country has a ban on all forms of direct and indirect advertising. This indicator is considered partially achieved if the country has a ban on national TV, radio and print media, but not on all other forms of direct and/or indirect advertising.
    Definition:
    Country has implemented a national anti-tobacco mass media campaign designed to support tobacco control, of at least 3 weeks' duration with all appropriate characteristics. Appropriate characteristics include: • campaign was part of a comprehensive tobacco control programme; • before the campaign, research was undertaken or reviewed to gain a thorough understanding of the target audience; • campaign communications materials were pre-tested with the target audience and refined in line with campaign objectives; • air time (radio, television) and/or placement (billboards, print advertising, etc.) was obtained by purchasing or securing it using either the organization’s own internal resources or an external media planner or agency (this information indicates whether the campaign adopted a thorough media planning and buying process to effectively and efficiently reach its target audience); • the implementing agency worked with journalists to gain publicity or news coverage for the campaign; • process evaluation was undertaken to assess how effectively the campaign had been implemented; • an outcome evaluation process was implemented to assess campaign impact; and • the campaign was aired on television and/or radio. This is indicator 5e from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Eligible campaigns are assessed according to the appropriate characteristics to determine whether it signifies the use of a comprehensive communication approach. This indicator is considered fully achieved if the country has a campaign conducted with at least seven appropriate characteristics including airing on television and/or radio. This indicator is considered partially achieved if the country has a campaign conducted with one to six of the appropriate characteristics. WHO assessment is shared with national authorities for review and approval.
    Definition:
    Country has all public places completely smoke-free (or at least 90% of the population covered by complete subnational smoke-free legislation).“Completely” means that smoking is not permitted, with no exemptions allowed, except in residences and indoor places that serve as equivalents to long-term residential facilities, such as prisons and long-term health and social care facilities such as psychiatric units and nursing homes. Ventilation and any form of designated smoking rooms and/or areas do not protect from the harms of second-hand tobacco smoke, and the only laws that provide protection are those that result in the complete absence of smoking in all public places. This is indicator 5b from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Legal instruments are analysed for the production of the WHO report on the global tobacco epidemic. Legislation (including implementing rules and regulations) is assessed to determine whether smoke-free laws adopted as of 31 December 2020 provided for a complete indoor smoke-free environment at all times, in all the facilities of each of the following eight places: health care facilities; educational facilities other than universities; universities; government facilities; indoor offices and workplaces not considered in any other category; restaurants or facilities that serve mostly food; cafes, pubs and bars or facilities that serve mostly beverages; public transport. This indicator is considered fully achieved if all eight categories of public places listed above are completely smoke-free in the country (or at least 90% of the population covered by complete subnational smoke-free legislation). This indicator is considered partially achieved if three to seven public places are completely smoke-free.
    Definition:
    Country has total taxes set at a level that accounts for more than 75% of the retail price of tobacco products. This is indicator 5a from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Data collected from governments for the production of the WHO report on the global tobacco epidemic. Total taxes (including excise tax, value added/sales tax, import duties (where applicable) and any other taxes levied) are calculated as a proportion of the price of the tobacco product. Currently, this is calculated in relation to the most sold brand of cigarettes. This indicator is considered fully achieved if the country has total taxes more than 75% of the price of the most sold brand of cigarettes. This indicator is considered partially achieved if the country has total taxes from 51% up to 75% of the retail price of the most sold brand of cigarettes.
    Definition:
    Country mandates plain/standardized packaging and/or large graphic warnings with all appropriate characteristics. Appropriate characteristics for large graphic warnings include: • specific health warnings mandated; • appearing on individual packages as well as on any outside packaging and labelling used in retail sale; • describing specific harmful effects of tobacco use on health; • are large, clear, visible and legible (e.g. specific colours and font style and sizes are mandated); • rotating health warnings and/or messages; • pictures or pictograms; and • written in (all) the principal language(s) of the country. Appropriate characteristics for plain/standardized packaging include: • restrictions or prohibitions on the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style; • standardized shape, size and materials of tobacco packaging; and • no advertising or promotion inside or attached to the package or tobacco product. This is indicator 5c from the NCD Progress Monitor (https://www.who.int/publications/i/item/9789240047761).
    Estimation method:
    Legislation (including implementing rules or regulations) adopted as of 31 December 2020 is assessed to determine the size of the warnings (the front and back of the cigarette pack are averaged to calculate the percentage of the total pack surface area covered by warnings) and warning characteristics. This indicator is considered fully achieved if the country has plain/standardized packaging and/or large graphic health warnings which are defined as covering on average at least 50% of the front and back of the package with all appropriate characteristics as detailed above. This indicator is considered partially achieved if there are medium-size warnings, which are defined as covering on average between 30 and 49% of the front and back of package, with some or all appropriate characteristics, or large warnings that are missing some appropriate characteristics. For countries with a law requiring plain/standardized packaging and/or large graphic warnings but with no implementing rules or regulations yet adopted as of 31 December 2020, this indicator will not be considered fully achieved.
    Definition:
    The country is a Party to the Protocol to Eliminate Illicit Trade in Tobacco Products.
    Estimation method:
    The country is considered a Party to the Protocol to Eliminate Illicit Trade in Tobacco Products 90 days after it formally deposits with the United Nations Treaty Collection its instrument of ratification, acceptance, approval or confirmation of, or accession to, the protocol. The official and most up to date list of Parties is available at https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IX-4-a&chapter=9&clang=_en
    Definition:
    The country is a Party to the WHO Framework Convention on Tobacco Control
    Estimation method:
    The country is considered a Party to the WHO Framework Convention on Tobacco Control 90 days after it formally deposits with the United Nations Treaty Collection its instrument of ratification, acceptance, approval of, or accession to, the treaty. The official and most up to date list of Parties is available at https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IX-4&chapter=9&clang=_en
    Definition:
    The percentage of the population aged 15 years and over who currently smoke any tobacco product on a daily or non-daily basis. Smoked tobacco products include cigarettes, pipes, cigars, cigarillos, waterpipes (hookah, shisha), bidis, kretek and heated tobacco products. Smoked tobacco products exclude e-cigarettes (which do not contain tobacco), “e-cigars”, “e-hookahs”, JUUL and “e-pipes”.
    Estimation method:
    A statistical model based on a Bayesian negative binomial meta-regression is used to model prevalence of current tobacco smoking for each country, separately for men and women. A full description of the method is available as a peer-reviewed article in The Lancet, volume 385, No. 9972, p966–976 (2015). Once the age-and-sex-specific prevalence rates from national surveys were compiled into a dataset, the model was fit to calculate trend estimates from the year 2000 to 2025. The model has two main components: (a) adjusting for missing indicators and age groups, and (b) generating an estimate of trends over time as well as the 95% credible interval around the estimate. Depending on the completeness/comprehensiveness of survey data from a particular country, the model at times makes use of data from other countries to fill information gaps. When a country has fewer than two nationally representative population-based surveys in different years, no attempt is made to fill data gaps and no estimates are calculated. To fill data gaps, information is “borrowed” from countries in the same UN subregion. The resulting trend lines are used to derive estimates for single years, so that a number can be reported even if the country did not run a survey in that year. In order to make the results comparable between countries, the prevalence rates are age-standardized to the WHO Standard Population. Estimates for countries with irregular surveys or many data gaps will have large uncertainty ranges, and such results should be interpreted with caution.
    Definition:
    The percentage of the population aged 15 years and over who currently use any tobacco product (smoked and/or smokeless tobacco) on a daily or non-daily basis. Tobacco products include cigarettes, pipes, cigars, cigarillos, waterpipes (hookah, shisha), bidis, kretek, heated tobacco products, and all forms of smokeless (oral and nasal) tobacco. Tobacco products exclude e-cigarettes (which do not contain tobacco), “e-cigars”, “e-hookahs”, JUUL and “e-pipes”.
    Estimation method:
    A statistical model based on a Bayesian negative binomial meta-regression is used to model prevalence of current tobacco use for each country, separately for men and women. A full description of the method is available as a peer-reviewed article in The Lancet, volume 385, No. 9972, p966–976 (2015). Once the age-and-sex-specific prevalence rates from national surveys were compiled into a dataset, the model was fit to calculate trend estimates from the year 2000 to 2025. The model has two main components: (a) adjusting for missing indicators and age groups, and (b) generating an estimate of trends over time as well as the 95% credible interval around the estimate. Depending on the completeness/comprehensiveness of survey data from a particular country, the model at times makes use of data from other countries to fill information gaps. When a country has fewer than two nationally representative population-based surveys in different years, no attempt is made to fill data gaps and no estimates are calculated. To fill data gaps, information is “borrowed” from countries in the same UN subregion. The resulting trend lines are used to derive estimates for single years, so that a number can be reported even if the country did not run a survey in that year. In order to make the results comparable between countries, the prevalence rates are age-standardized to the WHO Standard Population. Estimates for countries with irregular surveys or many data gaps will have large uncertainty ranges, and such results should be interpreted with caution.