new frontiers in ncds_sangiwa_5.1.12

1Management Sciences for Health

Stronger health systems. Greater health impact.

Dr. Gloria SangiwaDirector of Technical Quality and InnovationManagement Sciences for HealthCORE Group Spring Meeting, May 1, 2012

The Decade of Chronic Non-Communicable Diseases (C-NCDs)


Outline

• What are Chronic Non-Communicable Diseases (Chronic NCDs)?

• Why is there an increased global focus on the need to tackle Chronic NCDs in low and middle-income countries (LMICs)?

• What have been the global responses?

• What is needed to address Chronic NCDs in LMICs?


Chronic Non-Communicable Diseases Defined

Chronic Non-Communicable Diseases abbreviated as Chronic NCDs: • Defined as diseases or conditions that occur in, or are

known to affect, individuals over an extensive period of time and for which there are no known causative agents that are transmitted from one affected individual to another.

However:» Chronic conditions are not limited to non-

communicable diseases. Public health specialists increasingly view HIV/AIDS as a chronic condition.

» Some cancers are attributed to infectious agents (e.g. HPV and Cervical Cancer or Hepatitis and Liver Cancer).


What are the main Chronic NCDs and

why are they grouped together?


Big Four (+) and Causal Links

Big Four + : Cardiovascular Disease; Diabetes; Cancers; Chronic Respiratory Diseases

NCDs

Raised blood pressureOverweight/obesity

Raised blood glucoseRaised lipids

Tobacco useUnhealthy diet

Physical inactivityHarmful use of alcohol

GlobalizationUrbanization

Population ageing

Metab

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risk f

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Unde

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Beha

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risk f

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Causal links

[Source: WHO, Dr. Ala Alwan]

SocialDeterminants

of Health


Why we are seeing an increased global focus on addressing Chronic NCDs

in LMICs?


Chronic Non-Communicable Diseases (NCDs): A Global Challenge

There is a high and increasing global burden of chronic NCDs

Chronic NCDs account for 60% (35 million) of global deaths annually

80% (28 million) of these deaths occur in low- and middle-income countries

8 million preventable chronic NCD deaths occur among those < 60 years Comparison: AIDS, TB, and Malaria account for 6 million

Source: WHO


Age-standardized death rates for Chronic NCDs are higher in low & middle income countries

Total chronic NCD death rates, age standardized, Males, 2008

Source: WHO Global Health Observatory, 2011 www.who.int/gho/


Chronic NCDs are killing people at a younger age in low & middle income countries

Percentage of all chronic NCD deaths occurring under age of 70, Males, 2008



Cigarette consumption

Alcohol consumption

Overweight

Inadequatephysical activity

Chronic NCD major risk factors – vary among countries, often increasing with economic growth

Darker colors = increased risk (see source for specific risk levels)



Those in Developing Countries…

Tend to develop Chronic NCDs a decade earlier in life

Have more preventable complications

Are diagnosed at later stages (if at all)

Die sooner than those in high-income countries

Mortality from chronic NCDs before the age of 60 is 3x higher in poorer countries than in rich countries


Given current trends the problem will get worse before it gets better

Source: WHO, Global Burden of Disease, 2004, Figure 15

High Income Middle Income Low Income

Projected global deaths (millions of deaths)

33%

58%

89%


Projected increase of the Chronic NCDburden - low income countries

Chart based on WHO Global Burden of Disease, 2004, figure 15

2004 2030 (projected)

Number of Deaths for low income countries (each silhouette = 1 million annual deaths)

Chronic NCDs

HIV, TB, malaria, others

Maternal, perinatal, related

Accidents/ injuries


Global Responses: UN High-level Meeting “… the global burden and threat of non-communicable

diseases constitutes one of the major health challenges…”

“… which undermines social and economic development throughout the world…”

No major new funding for chronic NCDs

Focused on the problems without agreed solutions

Mobilized civil society movement, but public not yet fully engaged

Few champion countries


Setting Global Targets for Chronic NCDs

Mortality from chronic NCDs

Diabetes

Tobacco Smoke

Alcohol

Dietary salt intake

Blood pressure/hypertension

Obesity

Prevention of heart attack and stroke

Cervical cancer

screening

Elimination of industrially produced trans-fats from food supply

WHO recommends global targets for the following areas:


WHO’s Recommended Targets Target Area Target Goal

Mortality from NCDs 25% relative reduction in overall mortality from cardiovascular disease, cancer, diabetes, or chronic respiratory disease

Diabates 10% relative reduction in prevalence of diabetes

Tobacco smoking 40% relative reduction in prevalence of current tobacco smoking

Alcohol 10% relative reduction in persons aged 15+ alcohol per capita consumption (APC)

Dietary Salt intake Mean population intake of salt less than 5 grams per day

Blood pressure, Hypertension

25% relative reduction in prevalence of raised blood pressure

Obesity No increase in obesity prevalence

Prevention of heart attack and stroke

80% coverage of multidrug therapy (including glycaemic control) for people aged 30+ years with a 10 year risk of heart attack or stroke ≥ 30%, or existing cardiovascular disease

Cervical Cancer Screening

80% of women between ages 30 49 screened for cervical cancer at least ‐once

Trans-Fat Elimination of industrially produced trans fats (PHVO) from the food supply‐

Source: WHO, 2012


Responding to the Chronic NCD Epidemic – what is needed

Whole of society response – public, private, civil

society

Universal health coverage (UHC) for financing

base

Integration and localization from the beginning

High leverage prevention

Efficiency and cost-consciousness at every step


Now is the time for UHC – the example of the “African tigers” with two decades of growth

Emerging countriesThreshold countriesOther countriesOil exporters

Average Growth Rates per Capita, 1996–2008

Source: Emerging Africa,Steven Radelet, 2010


The Universal Health Coverage movement – Growing “buzz” around the globe

Stated interest in achieving UHC

Implementing UHC reforms


The Universal Health Coverage (UHC) Vision

World UHC Coverage: 4 out of 10 people are covered

Source: The Rockefeller Foundation; WHA Resolution 58.33 Geneva: WHO 2005

Out-of-Pocket Expenditure: 60%

World Coverage: 8 out of 10 people are covered

Out-of-Pocket Expenditure: 30%


Integration and localization – an example of leveraging existing platforms

Cervical and Breast Cancer Screening in Eastern Uganda (STAR-E)

• Integration of HIV/AIDS and cervical/breast cancer prevention and treatment services

• 484 women and girls living with HIV/AIDS screened for cervical and breast cancer in 18 health centers as part of HIV-related care

• 884 personal health assistants (PHAs)sensitized on family planning and elimination of maternal-to-child transmission

• Patient referrals for cryotherapy for cervicalcancer at regional hospitals


Source: Beaglehole et al, Lancet 2011.

Efficiency and cost-consciousness - targeting “best buy” interventions for prevention and treatment

Interventions Cost per person per year (US $)

China India Russia1. Tobacco use – Accelerated implementation of the WHO Framework Convention on Tobacco Control

0.14 0.16 0.49

2. Dietary salt – Mass-media campaigns and voluntary action by food industry to reduce consumption

0.05 0.06 0.16

3. Obesity, unhealthy diet, and physical inactivity – media campaigns, food taxes, subsidies, labeling, marketing restrictions

0.43 0.35 1.18

4. Harmful alcohol intake – Tax increases, advertising bans, and restricted access

0.07 0.05 0.52

5. Cardiovascular risk reduction – Combination of drugs for individuals at high risk of NCDs

1.02 0.90 1.73

Total cost per person 1.72 1.52 4.08


Take Away Messages

• The world faces a growing burden of chronic NCDs.

• Chronic NCDs pose a significant burden to the health system and economic development.

• Strategies exist to prevent and treat cancer, heart disease, diabetes and lung disease and cost just $1.20 per person per year in LMICs.

• The “business as usual” approach is not appropriate.

• Health systems strengthening and pharmaceutical management have been identified as one of the critical elements required to meet the long-term needs of people living with chronic NCDs.

• Chronic NCDs can be effectively addressed by leveraging existing platforms and investments.


Inspiring Quotes……..

“Non-communicable diseases(NCDs) represent an epidemic of gigantic proportions and the call to address them nationally, regionally, globally and to dispel the myths that enshroud them has an urgency that is impatient of further debate.” Sir George Alleyne, UN Special Envoy for HIV in the Caribbean and Former Chair of

the Caribbean Commission on Health and Development

“The global health community is at a critical crossroads. For the past decade, it

was essential to fund interventions for specific diseases because the number of infections was so vast. As demographics change and people are living longer, however, a health systems approach to NCDs has the greatest health impact and ensures that interventions are sustainable, efficient, and effective.” Jonathan D. Quick, MD, MPH, President and CEO, Management Sciences for Health

“As the world grapples with the combined challenges of economic slowdown; the increasing globalization of the economic system and of diseases; and growing demands for chronic care, the need for universal health coverage (and a strategy for financing it) has never been greater.” Dr. Margaret Chan, Director General, World Health Organization


Stronger health systems. Greater health impact.

Saving lives and improving the health

of the world’s poorest and most vulnerable people

by closing the gap between knowledge and action in

public health.

new frontiers in ncds_sangiwa_5.1.12

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