introduction to non communicable diseases
TRANSCRIPT
8/4/2019 Introduction to Non Communicable Diseases
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The relevance of
Noncommunicable Diseasesto the
Public Health
Nayyar R. Kazmi (adopted from WHO)
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Key Messages
1. Noncommunicable diseases in developing countries are a major publichealth and socio-economic problem. They are the major challenge todevelopment in the 21st century.
2. Affordable solutions exist to prevent 40 to 50% of premature deaths fromnoncommunicable diseases, which could save an estimated 14 million
lives per year in developing countries.3. Noncommunicable diseases should no longer be excluded from global
discussions on development.
4. WHO is establishing the Global Noncommunicable Disease Network(NCDnet) to promote collaborative action to support developing countries
in addressing noncommunicable diseases.
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Noncommunicable diseases in developing countriesare a major public health and socio-economic problem
The major challenge to developmentin the 21st century
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Noncommunicable Diseases4 Diseases, 4 Modifiable Shared Risk Factors
TobaccoUse Unhealthydiets PhysicalInactivity HarmfulUse ofAlcohol
Cardio-vascular
Diabetes
Cancer
ChronicRespiratory
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Total deaths around the world:58 million
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Total deaths around the world:58 million
Deaths from noncommunicablediseases around the world:35 million
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Total deaths around the world:58 million
Deaths from noncommunicablediseases around the world:35 million
Deaths from noncommunicable
diseases in developingcountries:28 million
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Total deaths around the world:58 million
Deaths from noncommunicablediseases around the world:35 million
Deaths from noncommunicable
diseases in developingcountries:28 million
Deaths from noncommunicablediseases in developing
countries which could havebeen prevented: an estimated14 million
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Noncommunicable DiseasesMortality among men and women aged 15-59 years (2004)
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0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
D e a t h s ( m i l l i o n s )
High income Middle income Low income
HIV, TB, malariaOther infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidents
Other unintentionalIntentional injuries
Noncommunicable DiseasesProjected Deaths in 2015 and 2030
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2005 2006-2015 (cumulative)
Geographicalregions (WHOclassification)
Totaldeaths
(millions)
NCDdeaths
(millions)
NCDdeaths
(millions)
Trend: Deathfrom infectious
disease
Trend: Deathfrom NCD
Africa 10.8 2.5 28 +6% +27%
Americas 6.2 4.8 53 -8% +17%
EasternMediterranean
4.3 2.2 25 -10% +25%
Europe 9.8 8.5 88 +7% +4%
South-East Asia 14.7 8.0 89 -16% +21%
Western Pacific 12.4 9.7 105 +1 +20%
Total 58.2 35.7 388 -3% +17%
Noncommunicable DiseasesDeath trends (2006-2015)
WHO projects that over the next 10 years, the largest increase indeaths from cardiovascular disease, cancer, respiratory disease anddiabetes will occur in developing countries.
( WH O C h r oni c D i s e a s eR e p or t ,2 0 0 5 )
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Macro-economic impact:
• World Economic Forum estimates high risk and likelihood of negative economicimpact from noncommunicable diseases
• Heart disease stroke and diabetes alone estimated to reduce GDP between 1-5% indeveloping countries
Impact at household level: • World Bank estimates that one-third of people living on US$1-2 a day die prematurely
of noncommunicable diseases
• People in developing countries die younger from noncommunicable diseases, often intheir most productive years
• Low-income households suffer from the cost of long term treatment and the cost of
unhealthy behaviours – Cost of caring for a family member with diabetes can be 23% of low-income household
– Poorest households spend more than 10% of their income on tobacco
– Cost of essential drugs to treat and cure cancer makes them unaffordable for the poor
Noncommunicable DiseasesSocio-economic Impact
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Asset price collapseRetrenchment from globalization
Oil and gas price spike
NCDs
Flu pandemic
Fiscal crisis
Food crisis
Infectious disease
h t t p : / / w w w . w e f o
r u m . o r g / p d f / g l o b a l r i s k / g l o b a l r i s k s 0 9 / g l o b a l_ r i s k s
_ 2 0 0 9 . p
d f
Noncommunicable DiseasesWorld Economic Forum: Global Risk Assessment 2009
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2006-2015 (cumulative)2005Lost national income frompremature deaths due to heartdisease, stroke and diabetes
Lost national income(billions)
Lost national income (billions)Countries
493Brazil
55818China
2379India
80.4Nigeria
311Pakistan
30311Russian Federation
30.1Tanzania
WHO: "Heart disease, stroke and diabetes alone are estimated toreduce GDP between 1 to 5% per year in developing countriesexperiencing rapid economic growth"
( WH O C h r oni c D i s e a s eR e p or t ,2 0 0 5 )
Noncommunicable DiseasesMacro-economic Impact: Lost National Income
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Smoking prevalence prevalence in Bangladesh (1995)
Noncommunicable DiseasesTobacco: The poorest people smoke the most
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Source: Path Canada 2003
Monthly household expenditure of tobacco vs. nutritious food among street children in Mumbai (India)
Noncommunicable DiseasesTobacco: Behaviours associated with risk factors are costly
186.1173.9
137.4
119
109.8
61.948.5 43.6
0
20
40
60
80
100120
140
160
180
200
Items Consumed
A
v g .
M o n t h l y E x p i n I N R
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Affordable solutions exist to
prevent 40 to 50% of premature deathsfrom noncommunicable diseases
These solutions can prevent an estimated
14 million premature deaths each yearin developing countries
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Noncommunicable DiseasesThe Global Response
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1. Integrating NCD prevention into thedevelopment agenda, and into policiesacross all government departments
2. Establishing and strengthening nationalpolicies and programmes
3. Reducing and preventing risk factors4. Prioritizing research on prevention andhealth care
5. Strengthening partnerships
6. Monitoring NCD trends and assessingprogress made at country level
Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners
Noncommunicable DiseasesGlobal Action Plan 2008-2013: Six Objectives
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Noncommunicable DiseasesProven National Policies and Plans
• Early detection of hypertension andother risk factors reduce heart
disease mortality 35-60%
• Multi-drug regimens for patientsreduce risk of heart disease andstroke
• Early detection and treatment of
cancers account for 30-80%reduction in mortality
• Universal access to preventive andcurative care essential
• Tobacco use
• Unhealthy diet
• Physical inactivity
• Harmful use of alcohol
Strengthening health care forpeople with noncommunicablediseases:
Reducing the level of exposure ofindividuals and populations to riskfactors:
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Noncommunicable DiseasesSelected Multi-sectoral Approaches to Reduce Tobacco Use
• Increase tax rates for tobacco products
• Enact and enforce completely smoke-free environments
• Make tobacco cessation advice available as part of primary health care
• Require effective package warning labels
• Enact and enforce legislation to ban any form of direct and indirect tobacco
advertising, promotion and sponsorship• Obtain free media coverage of anti-tobacco activities
• Implement counter-tobacco advertising
• Strengthen tax administration to reduce illicit trade in tobacco products
• For more information please refer to the Framework Convention on Tobacco Control
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Noncommunicable DiseasesSelected Multi-sectoral Approaches to Reduce Unhealthy Diet
• Reduce trans fatty acids and salt
• Restrict availability of energy dense foods and high calorie non-alcoholicbeverages
• Increase availability of healthier foods including fruits and vegetables
• Practice of responsible marketing to reduce impact of unhealthy foods to
children
• Make healthy options available and affordable
• Provide simple, clear and consistent food labels that are consumer friendly
• Reshape industry to introduce new products with better nutritional value
• For more information please refer to the Global Strategy on Diet Physical Activity and Health
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Noncommunicable diseases
should no longer be excludedfrom global discussions on
development
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African Union - Africa Health Strategy 2007-2015:
• The alarming rate of growth of the burden of bothdeath and disability from NCDs in Africa is ever morerecognised.
• Hypertension, stroke, diabetes, chronic respiratory
disease and the consequences of tobacco use,alcohol abuse and illicit drugs, are growing as seriouspublic health challenges.
• Each country needs to define, cost and implement abasic health care package that address the majorpart of its disease burden through appropriateinterventions using an integrated approach. Theinterventions would take care of the priority healthproblems both communicable and NCDs.
Noncommunicable DiseasesDeveloping countries are setting the agenda
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Declaration - Heads of Government of the Caribbean Community (2007):
• Provide leadership to implement NCD strategies• Establish multi-sectoral national commissions on NCDs• Implement the provisions of the WHO FCTC• Employ tax revenue from tobacco for preventing NCDs• Establish comprehensive national policies and plans•
Increase physical activity in the entire population, including in schools• Eliminate trans fasts• Promote greater use of indigenous agricultural products and foods• Mandating the labelling of foods
Noncommunicable DiseasesDeveloping countries are setting the agenda
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$0.10
$0.20
$0.30
$1.00$2.00
$2.70
$0.00
$0.08
$0.10
$0.20
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$0.60
$0.70
$1.30
$1.80
$1.93
$2.10
$4.75
Water Education/Training
Water resources protection
Waste management/disposal
River development
Basic drinking water supply & sanitationWater Policy/Management
Water supply/sanitation-large systems
Health Education
Health Training
Basic Nutrition
Family Planning
Medical Services
Medical Research
Basic Health Infrastructure
Reproductive Health Care
Basic Health Care
Health Policy/Management
Infectious Disease Control
STD & HIV/AIDS Control
Official Development Assistance for Health (2006, in US$ Billions, total is US$21 billion)
* O D A = O f f i c i a l D e v e l o
p m e n t A s s i s t a n c e p r o v i d e d b y 2 4 O
E C D / D A C d o n o r c o u n t r i e s , a s w e l l
a s t h e E C
Noncommunicable DiseasesDonors are not responding to requests for technical assistance
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• UN General Assembly Thematic Debate
• UN General Assembly Special Session on addressing noncommunicablediseases in developing countries
• World Summit on Noncommunicable Diseases
• Include an indicator on deaths from noncommunicable diseases in
developing countries under MDG Goal 6: during the 2010 MDG ReviewSummit
• Raise the priority accorded to addressing noncommunicable diseases inOfficial Development Assistance
Noncommunicable DiseasesEchoing calls to include noncommunicable diseases in the MDGs
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Global Noncommunicable Disease Network
(NCDnet)
Promoting collaborative action to help developingcountries in addressing noncommunicable diseases
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1. Integrating NCD prevention into thedevelopment agenda, and into policiesacross all government departments
2. Establishing and strengthening nationalpolicies and programmes
3. Reducing and preventing risk factors
4. Prioritizing research on prevention andhealth care
5. Strengthening partnerships
6. Monitoring NCD trends and assessingprogress made at country level
Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners
Noncommunicable DiseasesGlobal Action Plan 2008-2013: Six Objectives
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Promote results-orientedcollaborative efforts
Scale up by poolinglimited resources
Engage partners outsidethe health sector
Consolidatefragmented efforts
Noncommunicable DiseasesWhy working in partnership?
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Mission: Help implement the NCD Action Plan by catalyzing anmulti-sectoral, multi-level response, with a particularfocus on developing countries
Goals: • Increase focus on NCD prevention and control throughcollective advocacy
• Increase resource availability (both financial andhuman capital)
• Catalyze effective multi-stakeholder action with a focus
on country-level implementation
Noncommunicable DiseasesGlobal NCD Network
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Stakeholders outside the health sector: • Ministries of Finance, Trade, Education, Social Affairs• Development donors (e.g. Austrian Development Agency, Ministry of Foreign Affairs)•
International Financial Institutions• Intergovernmental Organizations• Private sector
Stakeholders from the disease
and risk factor community:
Noncommunicable DiseasesGlobal NCD Network: Stakeholders
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WorkingGroup
WorkingGroup
FundingMechanisms
Global/Regional Forum Meetings
Implemented in 2009
Implemented in 2010
International Advisory Council
WHO
Staff
Noncommunicable DiseasesGlobal NCD Network: Structure
WorkingGroup
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Thank you