Plenary Session 2 - Preventing Chronic Non-Communicable Lifestyle Related Diseases

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<p>Preventing Chronic Non-Communicable Lifestyle RelatedDiseases: A Vital InvestmentMs. Frances Prescilla Cuevas Chief Health Program Officer Degenerative Disease Office National Center for Disease Prevention and Control Department of Health</p> <p>Outline of the Presentation Global Situation Framework for Intervention Country Situation Way Forward for the Philippines Implications to Nursing</p> <p>MISUNDERSTANDINGS ABOUT CHRONIC DISEASES HAVE CONTRIBUTED TO THEIR GLOBAL NEGLECT</p> <p>Economic Burden of NCDsShare of Disease Burdens Falling Between Ages 15-69 in Low- and Middle-Income Countries, 2005 Disease category % Deaths 15-69 % DALYs 15-69</p> <p>A large share of the burden of NCDs occurs in populations of working age NCDs impose a significant burden not just on patients, but also on households, communities, employers, health care systems, and government budgets E.g., costs associated with tobacco and obesity in China and India are about 1-2% of GDP</p> <p>All causesAll NCDs -Cardiovascular diseases -Cancers All communicable diseases</p> <p>46%43% 38% 62% 35%</p> <p>54%74% 72% 81% 32%</p> <p>Source: Lopez and others. 2006. Global Burden of Disease and Risk Factors. New York: Oxford University Press. Data also available World Health Organization. Burden of Disease Project. World Health Organization. http://www.who.int/healthinfo/bodproject/en/index.html.</p> <p>16</p> <p>Noncommunicable Diseases Socio-economic ImpactMacro-economic impact: World Economic Forum estimates high risk and likelihood of negative economic impact from noncommunicable diseases Heart disease stroke and diabetes alone estimated to reduce GDP between 1-5% in developing countries</p> <p>Office of the WHO Representative in the Philippines</p> <p>Noncommunicable Diseases Socio-economic ImpactImpact at household level: World Bank estimates that one-third of people living on US$12 a day die prematurely of noncommunicable diseases People in developing countries die younger from noncommunicable diseases, often in their 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: 20% of lowincome household income 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 poorOffice of the WHO Representative in the Philippines</p> <p>Study on an Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension 1st part: Analyzed 3.5-year claims data from 2002-2005 2nd part: Conducted a survey of identified PhilHealth beneficiaries with hypertension based on claims data Specific aims of the study: 1. Describe the frequency of use of inpatient care for hypertension and costs reimbursed by PhilHealth, using existing claims data on all PhilHealth members admitted for hypertension treatment from 2002 2005 2. Assess pre and post-hospitalization medicines access and use and willingness to pay for outpatient medicines of PhilHealth members discharged in 2005 after treatment for hypertension</p> <p>Study on an Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension Conclusion: Lack of affordable access to outpatient antihypertensive medicines leads to avoidable disease progression and costly inpatient admissions. Inpatient care for hypertension and its sequelae is expensive and hypothesize that many hospitalizations could be avoided with appropriate antihypertensive therapy provided in ambulatory care.</p> <p> Avoiding expenditures for one hospitalization could pay for one year of anti-hypertensive medicine treatment for three (3) patients.</p> <p>Study on an Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension </p> <p>Recommendation:</p> <p>PhilHealth to explore options for providing outpatient medicines and care benefits for chronic conditions such as hypertension.</p> <p>Costs, Availability, and Affordability of Diabetes Care in the Philippinesby Higuchi, et all, WHO, 2008 About three-fourths of the diabetes patients had given up diabetes care because of financial difficulties at one time in the past. Sixty seven percent (67%) experienced shortage of money because of diabetes-related expenditure, and borrowed money or pawned assets. Philhealth coverage was lowest among the informal sector at 15%.</p> <p>Causation Pathway</p> <p>Causation Pathway</p> <p>Intervention Pathway</p> <p>Strategic Approach 1 1 2 2 3</p> <p>4</p> <p>Advocacy</p> <p>Research, Surveillance, Evaluation</p> <p>5Health Sector ResponseHealth sector governance Health sector leadership Integration of NCD prevention and control into national health strategy</p> <p>Whole of government responsePolitical will Political leadership Healthy public policies and laws</p> <p>6Health Systems Response(Health Systems Strengthening)</p> <p>7</p> <p>Whole of society responseCommunity leadership Intersectoral partnerships Community mobilization</p> <p>Health workforce development Health services organization/delivery Financing People-centred systems of care Focus on prevention</p> <p>Cost-effective strategies exist</p> <p>Office of the WHO Representative in the Philippines</p> <p>The Cost-Effectiveness of NCD Interventions Covers a Wide RangeDALYs averted per US$1 million spent Cost per DALY</p> <p>Taxation of tobacco products</p> <p>Selected Cost-effectiveness Ratios for Interventions against NCDs</p> <p>3-50</p> <p>20,000-330,000</p> <p>Treatment of acute myocardial infarction or heart attach with an inexpensive set of drugs (aspirin and beta-blocker) Treatment of acute myocardial infarction with inexpensive drugs plus streptokinase (costs and DALYs for this are in addition to what would have occurred with inexpensive drugs only) Lifetime treatment of heart attack and stroke survivors with a daily polypill combining four or five off-patent preventive medications Coronary artery bypass gaft or bypass surgery in specific identifiable risk cases, such as disease of the left main coronary artery (incremental to 4) Bypass surgery for less severe coronary heart disease and lifetime treatment (incremental to 4)</p> <p>10-25</p> <p>40,000-100,000</p> <p>600-750</p> <p>1,300-1,600</p> <p>700-1,000</p> <p>1,000-1,400</p> <p>&gt;25,000</p> <p> 126 mg/dL 240 mg/dL 160 mg/dL &lt; 40 mg/dL 200 mg/dL BMI 25.0</p> <p>21.0 3.9 4.0 8.1 76.6 8.7 20.2</p> <p>22.5 3.4 8.5 11.7 54.2 9.4 24.0</p> <p>25.3 4.8 10.2 11.8 64.1 14.6 26.6</p> <p>Distribution of population by physical inactivity Philippine NNS, FNRIPhysical Inactivity Domains 2003 (%) 2008 (%) P-value</p> <p>MalesOccupational Travel-related Leisure time physical activity &lt; 2 times per week Females Occupational Travel-related Leisure time physical activity &lt; 2 times per week 82.1 94.3 95.5 76.2 95.2 95.7 0.0035 0.6022 0.0001 67.0 91.0 90.0 76.3 93.8 89.1 0.0000 0.9999 0.1269</p> <p>Current smoking Prevalence</p> <p>Hazardous alcohol intake</p> <p>From Pedro, Benavides, &amp; Barba, 2006</p> <p>CURRENT NCD SITUATION STATISTICS SHOWS THAT PREVALENCE OF NCDs and its major RISK FACTORS CONTINUES TO RISE THIS SITUATION IN THE COUNTRY IS UNACCEPTABLE WHAT WE HAVE BEEN DOING IS NOT ENOUGH DRASTIC MEASURES NEED TO BE DONE</p> <p>PHILIPPINE COMMITMENT INCLUSION OF NCD PREVENTION AND CONTROL TO MDG COMMITMENT OF THE COUNTRY THROUGH THE MDGMAX INITIATIVEAnnounced by the Secretary of Health, Dr. Francisco T. Duque III, during the 4th Public Health Convention on NCD Prevention and Control last July 2008 convened by the PCPCNCD and affirmed by an Administrative Order operationalizing the Prevention and Control of Lifestyle Related NCDs, the goal is to reduce NCD mortality by 2% per year.</p> <p>Framework for Action, Philippines</p> <p>Office of the WHO Representative in the Philippines</p> <p>Adoption of an integrated, comprehensive and community based response to NCD prevention and control: Focuses on common risk factors Encompasses the three levels of disease prevention Emphasizes strategies which would benefit entire population Integrates across settings Makes explicit links to other government programmes and community based organizations Emphasizes intersectoral action</p> <p>Strategic Approach For The Prevention And Control Of Lifestyle Related Diseases1. 2. 3. 4. 5. 6. 7. Environmental Interventions Lifestyle Interventions Clinical Interventions Advocacy Research, Surveillance, Monitoring and Evaluation Networking and Coalition-Building Health Systems Strengthening</p> <p>Environmental Intervention: Governance Policy and legislation Creating supportive built environments</p> <p>Lifestyle Intervention: Information and Education</p> <p>Clinical Intervention: Provision of clinical preventive service packages Provision of Acute Care, Chronic Care, Rehabilitation Care, and Palliative care</p> <p>Advocacy: Further develop, implement and sustain health promotion initiatives on healthy lifestyle Utilize media and social marketing</p> <p>Research, Surveillance, Monitoring and Evaluation: Inclusion of lifestyle-related diseases in the national unified health research agenda Development of evidence based interventions</p> <p>Networking and Coalition Building: Collaborate with LGUs, private sector and other partners</p> <p>Health Systems Strengthening: Establish program structure and provide funding for addressing lifestyle-related diseases Strengthen human resources capacity Facilitate resource mobilization and establish sustainable financing mechanisms Strengthen referral mechanism</p> <p>Changing times- Need social engineering</p> <p>10/28/2010</p> <p>Healthy City-NCD-Cherian Varghese-China-July 2009</p> <p>THE MEDICAL MODELIndividual</p> <p>SCREEN</p> <p>DIAGNOSE</p> <p>Focus on Disease.</p> <p>TREAT (FIX)</p> <p>Lifestyle10/28/2010WPR Meeting on NCD Prevention and Control; 3-7 August 2009</p> <p>THE HEALTH PROMOTION MODELENABLING</p> <p>PROMOTE</p> <p>PREVENT</p> <p>Focus is on Health</p> <p>SUSTAIN</p> <p>ENVIRONMENT10/28/2010WPR Meeting on NCD Prevention and Control; 3-7 August 2009</p> <p>How then should we educate our nurses? Train nurses in health promotion with expertise on population based approaches and not only on the highly clinical individual focused interventions. Philippines: link with ADPCN and UP College of Nursing to strengthen and enhance teaching of health promotion and NCD prevention and control in the BSN curriculum</p> <p> Train nurses to become highly skilled in policy advocacy, networking and negotiation.</p> <p>Investing in Nurses Dr. Patricia Benner: Educating Nurses Creating a New Future, Global Alliance for Nursing and Midwifery WHO CC Elluminate Distinguished Lecturer Series advocates on reverting back to educating nurses in Primary Health Care Public Health- Health Promotion Model. Oct 13, 2010 Elluminate Conference</p> <p>Nursing Coming of Age Globally Nurses are knowledge workers who are educationally equipped to deliver knowledgeable health education and care, health promotion and illness prevention in all settings. Their work needs to be in Community Health Centers, Primary Health Care, and thus, be enabled to spend less time in higher technology tertiary care centers in order to prevent illness and improve the health of nations.</p> <p>Upstream interventionsPolicies/ lack of it in other sectors</p> <p>NCDs</p> <p>10/28/2010</p> <p>WPR Meeting on NCD Prevention and Control; 3-7 August 2009</p> <p> Cross over All sectors to work for health Health in all policies Back to Primary Health Care and Health Promotion10/28/2010WPR Meeting on NCD Prevention and Control; 3-7 August 2009</p> <p>Thank you!</p> <p>GUINNESS WORLD RECORDS The largest aerobics display involved 48,188 participants at Luneta Park Manila, Philippines, February 16, 2003</p>

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