non communicable disease: prevention and mangement

Non Communicable Diseases (NCDs)

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Dr. Nizam Uddin Ahmed• Faculty, PHD, North South University

• Email: [email protected]

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Outline

• Definition • Non-communicable disease mortality

worldwide• The Epidemiological Transition• Major risk factors• Infection and non-communicable diseases• Prevention & Control• Summary

Classifying deaths and diseases (WHO)

• Communicable diseases [Group I]– Those where death is directly due to the action of

a communicable agent• Non-communicable diseases

– Diseases [Group II]• Cancer, diseases of various organ systems (eg

respiratory, cardiovascular etc.), diabetes, mental health etc.

– External causes (injuries, poisonings and violence) [Group III]

What are NCDs?

• NCD is a medical condition or disease, which is not infectious

• NCDs are diseases or medical conditions with long duration and relatively slow progression

• NCDs are usually called “Chronic Diseases”

Why NCDs Are Important in Public Health?

• 65 million deaths that occurred globally in 2011

• 36 million – 63.2%, almost two thirds – were due to NCDs

• 9 million death that occurred among people under age 60

• mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases

Public Health Agency of Canada | Agence de la santé publique du Canada 14

1Except in sub-Saharan Africa.

NCDs are an increasing global challenge…

Most significant cause of death (63%) worldwide1

Even in African nations, NCDs are rising rapidly, projected to exceed communicable, maternal/perinatal, and nutritional diseases as the most common causes of deaths by 2020

NCDs cause premature deaths under age 60:13% in high income countries

29% in low middle income countries

Source: World Health Organization (WHO).

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• NCDs represent a major fiscal and productivity risks for the economies of low, middle, and high income countries

• NCDs increase income inequities, deplete household wealth, increase health spending and lower labour productivity

• Most countries will not be able to address NCD challenge with medical care alone: Prevention is critical

…and their impacts extend beyond health.

Source: World Bank 2011.

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The epidemiologic transition(Omran, 1971)

Change in the balance of disease in a population

from communicable diseases

to non-communicable disease

Urbanisation

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Urbanisation

0

10

20

30

40

50

60

70

80

90

100

1950 1960 1970 1980 1990 2000 2010 2020 2030

Urb

an p

opul

atio

n as

% o

f tot

al

North AmericaLatin America & Caribbean

Europe

Oceania

Asia

Africa

WORLD

2007

Drivers of the epidemiological transition in low and middle income countries• Population ageing• Major socio-economic changes (especially

urbanisation)– changes in risk factors such as diet, physical activity,

smoking etc.

Public HealthAgency of Canada

Agence de la santépublique du Canada

The Cost…

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…and NCD rates are increasing at 14 percent each year.

Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using POHEM Model, Statistics Canada.

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COSTS

Individual Household Employer Government

Health care

Out of pocket drugs

Lost productivity

Disability

Economic burden of NCDs

…and so is our economy. NCDs cost $190 billion in 2010.

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Canada’s declining deaths from heart disease due in part to an increase in treatment.


Treating NCDs is costly.

Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010; and CMAJ, July 7, 2009 - 1881 (1-2).

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 20060

20

40

60

80

100

120

140

0

1

2

3

4

5

6

Deaths

Expenditures

Years

Deaths per100,000 pop.

(sdr)

Expenditures on

cardiovascular disease

medication (Billion $)

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…but the economic impact goes beyond the health sector.

about twice the direct health care costs

Direct health care costs in 2010 = $68 billion

Indirect costs due to income and productivity losses = $122 billion estimated

Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from the Canadian Institute for Health Information and from the data of the Economic Burden of Illness in Canada,1986, 1993, 1998.

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The Cost-effectiveness Options…

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Source: Global Status Report on Noncommunicable Diseases 2010, World Health Organization.


Metabo

lic

/ph

ysiol

ogica

l

risk f

actor

s

Unde

rlying

drive

rsBe

havio

ural

risk f

actor

s

NCDs

Raised blood pressureOverweight/obesity

Raised blood glucoseRaised lipids

Tobacco useUnhealthy diet

Physical inactivityHarmful use of alcohol

GlobalizationUrbanization

Population ageing

SocialDeterminantsof Health

We understand the pathway to NCDs...

Public Health Agency of Canada | Agence de la santé publique du Canada

80% of heart disease, diabetes and respiratory diseases and 40% of cancers are preventable by eliminating four common risk factors

NCDs

Common risk factors

Tobacco use

Unhealthydiets

Physicalinactivity

Harmful useof alcohol

Cardiovasculardiseases

Diabetes

Cancer

Respiratorydiseases Source: WHO, Raising the priority of non-communicable disease in development

work at global and national levels.

…and we know prevention is critical.

Public Health Agency of Canada | Agence de la santé publique du Canada

For every $1 invested in labelling on cigarette packages there is a saving of $52 for the Canadian economy including $8 for Government1

For Worksite Health Promotion, the Atlantic Health and Wellness Institute found that returns per dollar ranged from $1.64 to $3.98 based on employee risk factors after 3 months of intervention2

Intervention for prevention works...

Sources: 1Health Canada, 2011.2Spencer & Associates, 2002.

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Assessing results of nine prevention approaches, a study using OECD/WHO model predict both the per capita investment costs and their likely outcomes in improving population health.

Mainly, the study concluded the best return for the prevention dollar came from a combination of several interventions from public and private sector sources.

… and healthy promotion is everyone’s business.

Health Outcomes at the Population Level (average effects per year)

School-based interventions

Mass media campaigns

Food advertising self-regulation

Food labelling

Worksite interventions

Food advertising regulation

Physician counselling

Fiscal measures

Physician-dietician counselling

0 10,000 20,000 30,000 40,000

Disability-adjusted life years

Life years

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The Macroeconomic options…

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Actions by many sectors have an impact on our lifestyles and health. NCDs

Agri-food

Work Places

Transport

Economic Development

Education

Income

Urban Planning

Environment and

Sustainable Development

Finance

Trade



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Conclusions…

Summary• Non-communicable diseases are now the

most common cause of death world wide• Increasing rates in low and middle income

countries because of change in lifestyles (urbanisation)

• Key risk factors have very large effects• Interventions are effective and can reduce

burden• The need to combine results and have large

studies35

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Group Work• Group 1: What are causes of NCDs and how

to prevent and control? • Group 2: Why Hypertension and Diabetics

are increasing and how to prevent and control?

• Group 3: NCDs mortality is high, why major programs are not in place?

• Group 4: What are major strategies of NCDs prevention and control in Bangladesh?

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Acknowledgements

• I would like to acknowledge all references that are utilized for this presentation.

non communicable disease: prevention and mangement

Healthcare