NONCOMUNICABLE DISEASES AS GLOBAL HEALTH PROBLEM. Part I

KAUNAS UNIVERSITY OF MEDICINE FACULTY OF PUBLIC HEALTH DEPARTMENT OF PREVENTIVE MEDICINE “INTERNATIONAL HEALTH: NONCOMUNICABLE DISEASES AS GLOBAL HEALTH PROBLEM” PROF. Vilius GRABAUSKAS FROM BISPH TRAINING COURSE PUBLIC HEALTH SCIENCE LEARNING OBJECTIVES UNDERSTAND THE TRANSITION IN GLOBAL HEALTH  TO  TO UNDERSTAND THE CAUSES OF THE ABOVE TRANSITION  TO UNDERSTAND WHO’s POLICY AND STRATEGIES TO COMBAT THE EPIDEMICS OF NONCOMMUNICABLE DISEASES Vilius GRABAUSKAS THE WORLD HEALTH IS IN TRANSITION EPIDEMIOLOGICAL : NCDS OVERRIDING INFECTIOUS DISEASES AND DOUBLE BURDEN OF DISEASES IN MANY DEVELOPING COUNTRIES LIFESTYLES: TOBACCO USE IS INCREASING DIETS ARE RAPIDLY CHANGING PHYSICAL ACTIVITY REDUCES ALCOHOL USE INCREASES, OBESITY, DIABETES, HYPERTENSION ARE INCREASING IN MOST PARTS OF THE WORLD, WHILE UNDER-NUTRITION REMAINS A SEVERE ISSUE DEMOGRAPHIC : POPULATION AGEING. Vilius GRABAUSKAS GLOBALIZATION : INCREASING GLOBAL INFLUENCES THE GLOBAL NCD REALITY  NONCOMMUNICABLE DISEASE CONTRIBUTE 60 % OF DEATHS AND 43 % OF THE GLOBAL BURDEN OF DISEASE. ALREADY 79% OF THESE NCDS ARE OCCURRING IN DEVELOPING COUNTRIES.  BY 2020 THESE DEATHS WILL ACCOUNT FOR 73% DEATHS AND 60% OF THE DISEASE BURDEN.  HALF OF THESE DEATHS ARE ATTRIBUTABLE TO CARDIOVASCULAR DISEASES.  THERE ARE MORE CVD DEATHS IN INDIA OR CHINA THAN IN ALL DEVELOPED COUNTRIES ADDED TOGETHER. Vilius GRABAUSKAS WORLD, DEATHS, BY BROAD CAUSE GROUP, 2001 Total deaths: 56,554,000 58,5% Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (18.4 million) Noncommunicable conditions (33.1 million) 32,5% 9,0% Injuries (5.1 million) Source: WHR 2002 Vilius GRABAUSKAS WORLD, DALY’s, BY BROAD CAUSE GROUP, 2001 45,9% Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 42,0% 12,2% Injuries Source: WHR 2002 Vilius GRABAUSKAS DEATHS, BY BROAD CAUSE GROUP AND WHO REGION, 2001 Noncommunicable conditions Injuries 75% Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50% 25% AFR AMR EMR EUR SEAR WPR Source: WHR 2002 Vilius GRABAUSKAS DALY’s, BY BROAD CAUSE GROUP AND WHO REGION, 2001 Noncommunicable conditions Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 75% 50% 25% AFR AMR EMR EUR SEAR WPR Source: WHR 2002 Vilius GRABAUSKAS WORLD, DISTRIBUTION OF CAUSES OF DEATH, 2001 Total deaths: 56,554,000 Other NCDs Respiratory infections Respiratory diseases Neuropsychiatric disorders 3% 6% HIV/AIDS 7% Digestive diseases 4% Perinatal conditions 5% 5% Malignant neoplasms Diarrhoeal diseases 3% 13% Tuberculosis 3% Childhood diseases Diabetes Malaria Maternal conditions 9% Nutritional deficiencies 30% Other CD causes Injuries Cardiovascular diseases Source: WHR 2002 Vilius GRABAUSKAS WORLD DISEASE BURDEN (DALY’s), 2001 Maternal conditions Respiratory infections Malaria 6% Childhood diseases 3% 3% Diarrhoeal diseases 4% HIV/AIDS 6% Tuberculosis Other CD causes 6% 12% Perinatal conditions Nutritional deficiencies Other NCDs 7% Malignant neoplasms 5% Diabetes Neuropsychiatric 13% disorders 3% 10% 3% 4% Sense organ disorders Injuries Congenital abnormalities Musculoskeletal diseases Source: WHR 2002 Cardiovascular diseases Respiratory diseases Digestive diseases Diseases of the genitourinary system Vilius GRABAUSKAS Please go to another Part of this lecture NCD’s ARE TO A GREAT EXTEND PREVENTABLE  KEY RISK FACTORS: UNHEALTHY DIET (SALTY, FATTY AND SUGARY FOOD), PHYSICAL INACTIVITY, TOBACCO AND ALCOHOL DRINKING.  THE BEHAVIOURAL FACTORS LEAD TO HIGH BLOOD PRESSURE & HYPERTENSION, BLOOD GLUCOSE INTOLERANCE & DIABETES, ELEVATED BLOOD CHOLESTEROL & HYPERCHOLESTEROL, ANAEMIA, OVERWEIGHT AND OBESITY.  SIMPLE CHANGES IN THESE LIFESTYLES CAN POWERFULLY PREVENT CHRONIC DISEASES AND PROMOTE HEALTH.  SOME OF THE CHANGES TAKE PLACE RELATIVELY QUICKLY AND ALSO IN LATE AGE. Vilius GRABAUSKAS WHAT PREVENTS EFFECTIVE NCD ACTION? MYTHS ABOUT NCDs: diseases of affluence, of ageing, of men UNDERESTIMATION OF PREVENTION IMPACT MYTH OF CONG DELAY IN PRENTION EFFECT LOW PUBLIC VISIBILITY (Perceived threat) LACK OF DIRECT ECONOMIC INTERESTS (vs drugs or clinical measures) CONFLICTING MESSAGES, often related to commercial interests INERTIA IN CHANCE: administration, financing, services etc Vilius GRABAUSKAS WHO RESPONSE  EVIDENCE BASE, ADVOCACY, SURVEILLANCE, TRAINING  NATIONAL PROGRAMMES AND POLICIES  REGIONAL ACTIVITIES : WHO REGIONAL OFFICES AND REGIONAL NETWORKS  GLOBAL ACTION: PARTNERSHIP, ATTENTION TO GLOBAL ASPECTS (MARKETING, TRADE, COMMUNICATION ETC)  SURVEILLANCE AND MONITORING Vilius GRABAUSKAS WHO RESPONSE WHO’S GLOBAL STRATEGY FOR NCD PREVENTION AND CONTROL (WORLD HEALTH ASSEMBLY 2000)  NCDS A PRIORITY  PREVENTION KEY  INTEGRATED PREVENTION  TARGETS MAIN COMMON RISK FACTORS - TOBACCO - UNHEALTHY DIET - PHYSICAL INACTIVITY Vilius GRABAUSKAS HEALTHY LIFESTYLES  FOR INDIVIDUAL: EFFECTIVE WAY TO PREVENT DISEASES AND PROMOTE HEALTH  FOR THE SOCIETY: A COST EFFECTIVE AND SUSTAINABLE WAY TO IMPROVE PUBLIC HEALTH Vilius GRABAUSKAS STRATEGIES TO REDUCE RISK: WORLD HEALTH REPORT 2002 MESSAGES  VERY SUBSTANTIAL HEALTH GAINS CAN BE MADE FOR RELATIVELY MODEST EXPENDITURES ON INTERVENTIONS  CHANGING POPULATION DISTRIBUTIONS OF RISK FACTORS (LIKE BLOOD PRESSURE, BLOOD CHOLESTEROL) THROUGH GENERAL LIFESTYLE CHANGES  CVD: POPULATION WIDE STRATEGIES TO LOWER CHOLESTEROL (QUALITY OF FAT) AND BLOOD PRESSURE (SALT REDUCTION) KEY  TOBACCO: HIGHER TAXES, COMPREHENSIVE ADVERTISEMENT BAN  MIX OF POPULATION WIDE, HIGH RISK AND SECONDARY PREVENTION MEASURES, IN A COST EFFECTIVE BALANCE  SUSTAINED POLICY ACTION  STRENGTHENING OF NATIONAL INSTITUTIONS TO IMPLEMENT AND EVALUATE RISK REDUCTION PROGRAMMES Vilius GRABAUSKAS NCD PREVENTION AND HEALTH PROMOTION NETWORKS GLOBAL INTEGRATED NCD PREVENTION NETWORKS CINDI CARMEN EMAN EUROPEAN NETWORK IN 27 COUNTRIES LATIN AMERICAN NETWORK IN 8 COUNTRIES INITIATIVE IN EASTERN MEDITERRANEAN REGION NANDI (SEARO) INITIATIVE IN THE AFRICAN REGION SOUTH EAST REGION: PLANS ARE UNDER WAY WESTERN PACIFIC REGION : PLANS ARE UNDER WAY (WPRO) MEGA COUNTRY HEALTH PROMOTION NETWORK: 11 COUNTRIES; OVER 100 MIL. PEOPLE Vilius GRABAUSKAS