time to act the wold heart federation advocacy toolkit
TRANSCRIPT
Time to Act
The Wold Heart Federation Advocacy Toolkit
Content
• The background -a look at the current NCDs and CVD situation
• Behind CVD -the risk factors• CVD and NCDs-a neglected development issue• We can act -the World Heart Federation’s and
the world’s global response
The background A look at the current NCDs and CVD situation
« NCDs are ranked as the third most likely risk to come true and the fourth most severe in its impact for 2009 »The World Economic Forum
Source: WHO Global Burden of Disease Report Update 2004, Geneva 2008
Note: NCDs: CVD, cancer, chronic respiratory, diabetes
Global Burden of Disease: NCDs cause over 50% of deaths worldwide
Source: WHO Global Burden of Disease Report Update 2004, Geneva 2008
Global Burden of Disease: NCDs responsible for high rates of premature mortality (deaths per 1000 in adults between 15-59 years)
NCDs: Leading cause of male deaths worldwide
WHO region
0
200
400
600
800
1000
1200
Africa Americas South-East Asia Europe EasternMediterranean
Western Pacific World
Communicable diseases, maternal and perinatal conditions, and nutritional deficienciesChronic diseasesInjuries
WHO region
Source : «Preventing Chronic Diseases: A Vital Investment», WHO, 2005
Projected main causes of death in males by WHO region, all ages, 2005
Ag
e-st
and
ard
ized
dea
th r
ates
per
100
,000
NCDs: Leading cause of female deaths worldwide
WHO region
0
200
400
600
800
1000
1200
Africa Americas South-East Asia Europe EasternMediterranean
Western Pacific World
Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies
Chronic diseases
Injuries
WHO region
Projected main causes of death in females by WHO region, all ages, 2005
Ag
e-st
and
ard
ized
dea
th r
ates
per
100
,000
Source : «Preventing Chronic Diseases: A Vital Investment», WHO, 2005
Among NCDs, CVD is leading cause of death worldwideEstimated global deaths by cause, all ages, 2005
HIV/AIDS
TuberculosisMalaria
Cardiovascular diseases
Cancer
Chronic respiratory diseases
Diabetes
0
2000000
4000000
6000000
8000000
10000000
12000000
14000000
16000000
18000000
20000000
Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»
Burden of CVDMen and women by region
0
2
4
6
8
10
EURO EMRO AFRO PAHO SEARO WPRO
Nu
mb
er o
f C
VD
dea
ths
in m
illio
ns
Source: WHO Country Profiles, 2002, www.who.int
136
18
73
13
8
18
70
3
8
17
26
46
3
10
22
34
31
6
12
23
27
32
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Portugal (10% )
USA (12% )
Brazil (28% )
India (35% )
S. Africa(41% )
75+
65-74
55-64
45-54
35-44
Source : “A Race Against Time”, The Earth Institute, Colombia University, Stephen Leeder, 2004
A higher % of CVD deaths occur between 35 and 64 years of age in countries with developing economies
Disease burden of CVD and NCDs falls heavily on those between the ages of 15 & 69 in low- and middle-income countries (2005 figures)
Source : “Public Policy and the Challenge of Chronic Noncommunicable Diseases”, World Bank, 2007
0
10
20
30
40
50
60
70
80
% of deaths accounted for by thoseaged 15-69
% of DALYs accounted for bythose aged 15-69
Disease category (millions)
Per
cen
tag
e
All NCDs
CVD
DALY (Disability Adjusted Life Year)= The sum of years of potential life lost due to prematuremortality and the years of productive life lost due to disability.
« The NCDs epidemic threathens to overwhelm health systems »WHO, ECOSOC meeting 2009
« The costs of NCDS create a poverty trap (…) The epidemic of NCDs slows economic
growth »WHO, ECOSOC meeting 2009
There is a « bitter irony in promoting health as a poverty reduction strategy at a time when the costs of health care themselves can be a cause of poverty »Her Royal Highness Princess Muna Al-Hussein, Ecosoc Meeting 2009
Lost national income from premature deaths due to heart disease, stroke and diabetes
2005 2006-2015 (cumulative)
CountriesLost national income
(billions)Lost national income
(billions)
Brazil 3 49
China 18 558
India 9 237
Nigeria 0.4 8
Pakistan 1 31
Russian Federation 11 303
Tanzania 0.1 3
WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth"
Source: WHO Chronic Disease Report,
2005
NCDs macro-economic impactLost National Income
« In Oman, it is estimated that there will be a 210% increase in the demand for health care by 2025, and treatment for cardiovascular diseases alone will account for 21% of total health care expenditures »WHO, ECOSOC Meeting 2009
« Conservatives estimates in Brazil, China, India, Mexico, and South Africa indicate that each year at
leat 21 million years of future productive life are lost because of CVD »
WHO, ECOSOC Meeting 2009
CVD macro-economic impact
• CVD is expensive for the world. It costs the European Union US$ 219 billion (€169 billion). The most updated data from USA shows that CVD costs nearly US$ 403 billion in direct and indirect costs
• By comparison, the estimated cost of all cancers is US$ 189 billion (€146.19 billion) and HIV US$ 28 billion (€22.4 billion)
• The economic burden is no longer confined to the affluent, industrial world
• In developing countries CVD disproportionately affect the working-age adults from lower socio-economic groups
• In 1995, the costs of tobacco-related disease accounted for 1.5% of GDP in China, and obesity-related costs were
equivalent to 1.1% of the GDP
Source: WHO, Hu & Mao, 2002; Leeder et. Al. 2004
2005 2006-2015 (cumulative)
Geographical regions (WHO classification)
Total deaths
(millions)
NCD deaths
(millions)
NCD deaths
(millions)
Trend: Death from infectious
disease
Trend: Death from NCD
Africa 10.8 2.5 28 +6% +27%
Americas 6.2 4.8 53 -8% +17%
Eastern Mediterranean
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%
NCDs: ProjectionsDeath trends (2006-2015)
WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries.
(WH
O C
hro
nic D
isea
se R
ep
ort,
20
05
)
0
5
10
15
20
25
30
2004 2015 2030 2004 2015 2030 2004 2015 2030
De
ath
s (
mill
ion
s)
High income Middle income Low income
HIV, TB, malaria
Other infectious
Mat//peri/nutritional
CVD
Cancers
Other NCD
Road traffic accidentsOther unintentionalIntentional injuries
NCDs: ProjectionsProjected Deaths in 2015 and 2030
CVD
CVD: Projections
• Contact WHO
Behind CVD The risk factors
« Multiple studies confirm the rise of NCDs and risk factors around the world. But the rise in risk factors is only partly explained by a change in personal behaviours. Personal behaviours are not only a personal choice. Much larger forces are at play here »WHO, ECOSOC Meeting, July 2009
NCDs: Risk factors4 Diseases, 4 Modifiable Shared Risk Factors
TobaccoUse
Unhealthy diets
Physical Inactivity
HarmfulUse of Alcohol
Cardio-vascular
Diabetes
Cancer
ChronicRespiratory
Source: Path Canada 2003
Monthly household expenditure of tobacco vs. nutritious food among street children in Mumbai (India)
NCDs: Risk factors’ impactTobacco: Behaviours associated with risk factors are costly
186.1173.9
137.4
119109.8
61.948.5 43.6
020406080
100120140160180200
Gutkh
a
Cigare
ttes
Mut
ton/
Chic
ken/
Bee
f
Paan
with to
bacc
oBidi
Milk
Fruits
Eggs
Items Consumed
Avg
. M
on
thly
Exp
in
IN
R
Source : “Global Burden of Disease and Risk Factors”, Lopez and others, Oxford University Press, 2006
CVD: Risk factors6 of top 10 risk factors in low- and middle- income countries lead to CVD
Risk factor for CVD
CVD: Risk factorsProjected progression of hypertension
0
400
800
1200
1600
2000 2025
Nu
mb
er
of
ad
ult
s l
ivin
g w
ith
hy
pe
rte
ns
ion
in
mil
lio
ns
Source: International Society of Hypertension
CVD: Risk factors Trends in Hypertension
• More than 20 million people have hypertension in Africa, with a prevalence ranging from 25% to 35% in adults aged 25-64 years*• In China, 18.8% above 18 of the population suffers from high blood pressure** • In England, 32.1 % of people above 16 suffer from high blood pressure***, and 2 out of 3 people above 65 suffer from it as well****
*WHO Regional Office for Africa (WHO/AFRO), The Health of the People: The African Regional Health Report (2006). WHO Geneva 2006**WHO Global Infobase, 2002 data for China***WHO Global Infobase, 2003 data for England****NHS, Health Survey for England, 2005
CVD: Risk factorsTrends in Tobacco
• 20.4% of Australian women 26.2% of men above 18 and smoke*
• In France, 26.5 % of women and 33.3% of men between 12 and 75 are current users of tobacco**
• In Chile, 43.6% of males and 31.8% of females above 15 are current users of cigarettes***
• In Indonesia, 63.5% of males are daily users of tobacco****
*,**,***,**** WHO Global InfoBase, countries surveys from various years
CVD: Risk factorsTobacco use on the rise in developing countries
« When money is tight, the first thing that drop out of the diet are usually healthy foods, like fruits, vegetables, and lean sources of protein, which are nearly always more expensive.Processed foods (…) become the cheapest way to fill a hungry stomach. This is the type of diet linked to the rise of chronic diseases. »Dr. Margaret Chan, ECOSOC Meeting, July 2009
CVD: Risk factors: Trends in Obesity
• Worldwide, 30% of women and 40% of men are now overweight and 27% of women and 24% of men are obese*
• In China, 18.8% of women and 19.1% of men above 18 are overweight or obese**
• In South Africa, 56.2% of women 29.1% of men above 15 and are overweight or obese***
• In the US, 31.1 % of males and 33.2% of females above 20 are obese****
• In 2007, an estimated 22 million children under the age of 5 years were overweight throughout the world*****
• More than 75% of overweight and obese children live in low- and middle-income countries******
* Balkau B, et al. A Study of Waist Circumference, Cardiovascular Disease, and Diabetes Mellitus in 168 000 Primary Care Patients in 63 Countries. Circulation, 2007;116:1942-1951
**,***,****,***** WHO Global InfoBase, countries surveys from various years
*****; ******WHO http://www.who.int/dietphysicalactivity/childhood/en/
CVD: Risk factors Childhood obesity trends around the world
CVD: Risk factorsProjected prevalence of overweight and obese school children by region today and in 2010
Source: Wang Y, Lobstein T, Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity. 2006; 1:11-25
0
20
40
60
80
100
Americas Eastern Med Europe South East Asia West Pacific
27.7%
46.4%
23.5%
41.7%
25.5%
38.2%
10.6%
22.9%
12%
27.2%
CVD and NCDs:A neglected development issue
« Non-communicable diseases are responsible for twice the number of deaths caused by infectious diseases yet receive only a tiny fraction of national and development heath funding »
Cherie Blair, ECOSOC Meeting, July 2009
« There does not seem to be a consensus among development agencies on the need to include non-
communicable diseases (…) in global discussions on development »
Dr.Ala Alwan, ECOSOC Meeting, July 2009
« The greatest burden of preventable death and disability in both rich and poor countries is being caused by the very conditions that are receiving least Official Development Assistance »Her Royal Highness Princess Muna Al-Hussein, ECOSOC Meeting, July 2009
$0.00
$0.10
$0.20
$0.30
$1.00
$2.00
$2.70
$0.00
$0.08
$0.10
$0.20
$0.20
$0.60
$0.70
$1.30
$1.80
$1.93
$2.10
$4.75
Water Education/ Training
Water resources protection
Waste management/ disposal
River development
Basic drinking water supply & sanitation
Water Policy/ Management
Water supply/ sanitation-large systems
Health Education
Health Training
Basic Nutrition
Family Planning
Medical Services
Medical Research
Basic Health Infrastructure
Reproductive Health Care
Basic Health Care
Health Policy/ Management
Infectious Disease Control
STD & HIV/ AIDS Control
Official Development Assistance for Health(2006, in US$ Billions, total is US$21 billion)
*O
DA
= O
ffic
ial D
evel
opm
ent
Ass
ista
nce
prov
ided
by
24 O
EC
D/D
AC
don
or c
ount
ries,
as
wel
l as
the
EC
NCDsDonors are not responding to requests for technical assistance
Worldwide, current investement in CVD and other chronic diseases is outrageoulsy low…
• The Global Fund for HIV/AIDS, TB and Malaria total pledges paid to date: USD 11.8 billion
• Since 2000, the World Bank has so far made available nearly US$ 1.2 billion to fund HIV/AIDS programmes in Africa
• In 2006, the International Finance Facility for Immunization launched a bond that raised US$ 1 billion
• Total contributions to GAVI for the year 2007 amounted to US$ 786 million
• Half of the US$ 1.8 billion allocated to health programmes by USAID in 2003 were for HIV/AIDS and infectious diseases. Another 45% were for maternal health, child survival and population control.
• For the 2008-2009 biennum, the WHO will allocate almost US$ 900 million to communicable disease whereas the budget allocated to non-communicable disease barely reaches US$ 160 million.
…but progress is being made slowly
• Despite the apparent imbalance in the WHO budget, the funding for non-communicable disease for the 2008-2009 biennium represents a 44% increase from the 2006-2007 budget
• It now represents 4% of WHO total budget (total budget is roughly US$ 3.3 billion)
• Tobacco control, one of CVD main risk factors, is getting more and more funds: the Bloomberg initiative had an endowment of US$ 125 million, directed at low- and middle-income countries. US$ 250 million have recently been added to this pledge
• The Bill and Melinda Gates Foundation is now getting involved in tobacco control, by pledging US$ 125 million
• The Alliance for a Healthier Generation (USA) has so far received US$ 28 million from the Robert Johnson Foundation for its Healthy Schools programme
• Ovations is contributing US$ 15 million to create centres to counter chronic disease in developing countries
• The UK Medical Research Council supports the OxHA Grand Challenges in Chronic Non-Communicable Disease with a £6 million grant
• In 2007, IDF received a multi-year grant of US$ 10 million for it BRIDGES programme which provides grants to fund translational research projects in diabetes prevention
« We must make the prevention and control of non-communicable diseases and improvement of maternal health top priorities of the development agenda (…). Both are begging for more attention »Dr. Margaret Chan, ECOSOC Meeting, July 2009
« I want to highlight the glaring omission of non-communicable diseases in the MDGs (…). This anomaly should be corrected »
Dr. Leslie Ramsammy, ECOSOC Meeting, July 2009
A neglected development issue:CVD and NCDs are not included in the United Nations Millennium Development Goals
1. Eradicate poverty and hunger
2. Achieve primary universal education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Cardiovascular and other chronic diseases
must be included
We can actThe world’s and the World Heart Federation’s global response
« We know the major steps that need to be taken to reverse this tidal wave of non-communicable diseases »Cherie Blair, ECOSOC Meeting, July 2009
« Control of non-communicable disease (is a) fully ready and mature area for efficient
interventions with a huge return »Margaret Chan, ECOSOC Meeting, July 2009
NCDs:The Global Response: example at the WHO level
NCDs: Fighting risk factorsSelected 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
NCDs: Fighting risk factorsSelected Multi-sectoral Approaches to Reduce Unhealthy Diet
•Reduce trans fatty acids and salt•Restrict availability of energy dense foods and high calorie non-
alcoholic beverages• 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
CVD: The World Heart Federation’s answer
Together with its members, the WHF achieves its mission through:
• Awareness Building• Advocacy• Demonstration Projects• Sharing Science/Building Capacity
• World Heart Day
• Go Red for Women
• Children/Adolescents:
- Sesame Workshop - Youth leadership
• Framework Convention on Tobacco Control
• WHO Global Strategy on Diet, Physical Activity & Health
• CVD in Millennium Development Goals
• Wellness in the workplace
• Healthy Active Youth programme
• RF/RHD secondary prevention project in South Pacific/Africa
• Plaza Sésamo Colombia/Youth advocacy
• China Bridging the Gap
• The Polypill
• Grenada Heart Project
Scientific Meetings• World Congress of
Cardiology
• Bi-annual Continental Society Congresses
Continuing Education
• Fellowships
Journals
• Nature: Clinical Practice CV Médicine
• CVD Prevention & Control
Awareness Building AdvocacySharing Science
CVD:World Heart Federation’s Activities
Building capacity
Applied Research
CVD:Working with members to fight the disease
0
50
100
150
200
250
2002 2008
Associate International
Associate National
National - Foundations
National - Societies
Continental
195
165
WHF’s membership in 2002 and today
CVD:Working with members to fight the disease
0
10
20
30
40
50
60
70
80
90
Afr 02 Afract.
Amrs02
Amrsact.
AP 02 APact.
Eur 02 Euract.
Assoc International
Assoc National
Nat'l foundations
Nat'l societies
Continental
WHF’s membership by region in 2002 and today
Algerian Society of Cardiology
Argentine Society of Cardiology
The Cardiac Society of Australia & New Zealand
Austrian Society of Cardiology
Bangladesh Cardiac Society
Belarusian Scientific Society of Cardiologists
Belgian Society of Cardiology
Bolivian Society of Cardiology
Association of Cardiologists of Bosnia & Herzegovina
Brazilian Society of Cardiology
Bulgarian Society of Cardiology
Canadian Cardiovascular Society
Chilean Society of Cardiology & Cardiovascular Surgery
Chinese Society of Cardiology
Colombian Society of Cardiology
Croatian Cardiac Society
Cuban Society of Cardiology
Cyprus Society of Cardiology
Czech Society of Cardiology
Danish Society of Cardiology
Dominican Society of Cardiology
Ecuadorian Society of Cardiology
Egyptian Society of Cardiology
Society of Cardiology of El Salvador
Finnish Cardiac Society
French Society of Cardiology
Georgian Association of Cardiology
German Cardiac Society
Ghana Society of Hypertension and Cardiology
Hellenic Cardiological Society
Guatemala Association of Cardiology
Honduras Society of Cardiology
Hong Kong College of Cardiology
Hungarian Society of Cardiology
Cardiological Society of India
Indonesian Heart Association
Iranian Heart Association
Iraqi Cardio-Thoracic Society
Irish Cardiac Society
Israel Heart Society
Italian Federation of Cardiology
Japanese Circulation Society
Jordan Cardiac Society
Association of Cardiologists of Kazakhstan
Kenya Cardiac Society
The Korean Society of Circulation
Association of Doctors of Internal Medicine of Kyrgyz RepublicLatvian Society of Cardiology
Lebanese Society of Cardiology and Cardiac Surgery
Libyan Cardiac Society
Lithuanian Society of Cardiology
Macau Association of Cardiology
Macedonia Society of Cardiology
National Heart Association of Malaysia
Mexican Society of Cardiology
Moldavian Society of Cardiology
Moroccan Society of Cardiology
Cardiac Society of Myanmar Medical Association
Cardiac Society of Nepal
The Netherlands Society of Cardiology
Nicaraguan Society of Cardiology
Nigerian Cardiac Society
Norwegian Society of Cardiology
Pakistan Cardiac Society
Society of Cardiology of Panama
Paraguayan Society of Cardiology
Peruvian Society of Cardiology
Philippine Heart Association
Polish Cardiac Society
Portuguese Society of Cardiology
Puerto Rican Society of Cardiology
Romanian Society of Cardiology
Society of Cardiology of the Russian Federation
San Marino Society of Cardiology
Saudi Heart Association
Society of Cardiology of Serbia and Montenegro
Singapore Cardiac Society
Slovak Society of Cardiology
Slovenian Society of Cardiology
The South African Heart Association
Spanish Society of Cardiology
Sri Lanka Heart Association Swedish Society of Cardiology
Swiss Society of Cardiology
Syrian Cardiovascular Association
Taiwan Society of Cardiology
The Heart Association of Thailand
Turkish Society of Cardiology
Ukrainian Society of Cardiology
Emirates Cardiac Society
British Cardiovascular Society
American College of Cardiology
Uruguayan Society of Cardiology
Venezuelan Society of Cardiology
Vietnam National Heart Association
Member National Societies
CVD:Working with members to fight the disease
Argentine Heart Foundation
National Heart Foundation of Australia
Austrian Heart Foundation
National Heart Foundation of Bangladesh
Heart Foundation of Barbados
Belgian Heart League
Foundation of Health and Heart (Bosnia and Herzegovina)
Brazilian Heart Foundation (FUNCOR)
Heart And Stroke Foundation of Canada
Chilean Heart Foundation
Un Coeur pour la Vie (Congo Brazzaville)
Cyprus Heart Foundation
Healthy Nutrition Forum (Czech Republic)
Danish Heart Foundation
Dominican Heart Foundation
Ecuadorian Foundation of Cardiology
Estonian Heart Association
Finnish Heart Association
Georgian Heart Foundation
German Heart Foundation
Ghanaian Heart Foundation
Hellenic Heart Foundation (Greece)
Hong Kong Heart Foundation
Hungarian National Heart Foundation
Icelandic Heart Association
Seychelles Heart and Stroke Foundation
Singapore Heart Foundation
Slovak League Heart to Heart
Slovenian Heart Foundation
Heart and Stroke Foundation South Africa
Spanish Heart Foundation
Swedish Heart Lung Foundation
Swiss Heart Foundation
Taiwan Heart Foundation
The Heart Foundation of Thailand
Turkish Heart Foundation
British Heart Foundation
American Heart Association
Venezuelan Heart Foundation
All India Heart Foundation
Heart Foundation of Indonesia
Irish Heart Foundation
Italian Heart Foundation
The Heart Foundation of Jamaica
Japan Heart Foundation
Kenya Heart Foundation
Kuwait Heart Foundation
Lithuanian Heart Association
Macau Heart Foundation
The Heart Foundation of Malaysia
Mauritius Heart Foundation
Nepal Heart Foundation
Netherlands Heart Foundation
The National Heart Foundation of New Zealand
Nigerian Heart Foundation
Norwegian Council On Cardiovascular Disease
Pakistan Heart Foundation
Cardiological Foundation of Panama
National Heart Foundation of Papua New Guinea
Paraguayan Heart Foundation
Heart Foundation of the Philippines
Portuguese Heart Foundation
Foundation for Cardiac Assistance (Romania)
Serbian Heart Foundation
Member National Heart Foundations
CVD:Working with members to fight the disease
CVD:Leveraging Partnerships
InternationalOrganizations
NGOs/Not forProfitAssociations
CorporatePartners/MajorSponsors
• Quote by WHF