review of ncds: current situation &future prospect
DESCRIPTION
Review of NCDs: Current Situation &Future Prospect. Orratai Waleewong Health Promotion Policy Research Center (HPR) International Health Policy Program (IHPP), Thailand. Outline. Global Epidemic of NCDs NCDs and Socio-economic development Poverty and productivity MDGs - PowerPoint PPT PresentationTRANSCRIPT
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Review of NCDs:Current Situation &Future
Prospect
Orratai Waleewong Orratai Waleewong
Health Promotion Policy Research Center (HPR)Health Promotion Policy Research Center (HPR)International Health Policy Program (IHPP), ThailandInternational Health Policy Program (IHPP), Thailand
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Outline
• Global Epidemic of NCDs• NCDs and Socio-economic development– Poverty and productivity– MDGs
• Global movement on NCDs• Best Buy Intervention: Policy and
intervention to prevent and control NCDs
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Global Risks Landscape 2013 (World Economic Forum)
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Imp
act
if t
he r
isk w
ere
to o
ccu
r
Likelihood to occur in the next
The Dangers of Hubris on Human
Health
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Global Epidemic of NCDs
• NCDs caused 36 million deaths (60 %) of global deaths (2008) 80% of these occur in developing countries
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10 million
15 million
20 million
25 million
0.6M
0.5M
3.3M
Lower middle-income
2.3M
10.2M10.2M
3.3 M3.3 M3.0M
3.0M
2.3M
Upper middle-income
3.0M3.0M
1.1M
High-income countries
5.9M5.9M
0.9M
Injuries
Other deaths from NCDs
Premature deaths from NCDs (below age of 60), which are preventable
Communicable diseases, maternal, perinatal and nutritional conditions
Source: The Global Burden of Disease 2004
Annual number of deaths in the world
Low-income countries
6.8 M6.8 M
13.6M13.6M
3.7M
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5Source: Institute for Health Metrics and Evaluation, ‘The Global Burden of Disease: Generating Evidence, Guiding Policy: 2012.
10 leading diseases & injuries and 10 leading risk factors based on percentage of global deaths and
DALYs, 2010.
NCDs account for 65.5% of all deaths, 54% of DALYs
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NCDs mortality by countries (2008 estimates)
% NCD deaths(all ages)
% NCD deaths under age 60
Males Female
Australia 90 13.4 9.2
Bangladesh 52 37.5 38.7
Bhutan 53 32.5 32.6
China 83 22.8 17.4
India 53 38.0 32.1
Indonesia 64 33.9 26.3
Japan 80 11.6 7.0
Myanmar 40 32.4 26.3
Thailand 71 32.3 25.0
Vietnam 75 26.4 19.46
World Health Organization - NCD Country Profiles , 2011.
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Poverty contributes to NCDs and NCDs contribute to poverty
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• Poverty: Household income is spent on health care for NCDs, medicines, tobacco and alcohol use
• Hunger: Underweight children and overweight adults are often found in the same households
• Maternal health: Malnutrition increases the risk of gestational diabetes and poor maternal health, high prevalence of cervical cancer (300,000 a year)
• Child health: Malnutrition in pregnancy is associated with a vulnerability to obesity, cardiovascular disease and diabetes later in life
• Education: NCD-related costs displace household resources for education
• HIV/AIDS: Increases the risk of cancers, and ARVs increase the risk of cardiovascular diseases
• Tuberculosis: Tobacco and alcohol use, and diabetes are associated with TB deaths
• Essential drugs: Cost-effective medicines to treat NCDs are available in low-cost generic forms, but remain inaccessible and unaffordable to most who need them
NCDs undercut the attainment of the MDGs
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The average cost for LMICs to scale up action by implementing the “best buy interventions”
US$ 170 billion for 2011-2025US$ 11.4 billion per year US$1 per capita in LICs, 1.5 in LMICs & 3 in UMICs
The cumulative economic lost output in developing countries associated with NCDs
US$ 7 trillion over 2011-2025• US$ 500 billion per year• US$ 25 in LICs, 50 in LMICs & 139 in UMICs
Cost of inaction Vs Cost of action
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4 NCDs X 4 common risk factors
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SocialDeterminants
of Health
What is driving the NCD epidemic?
Political Declaration on NCDs
UNGA High-level Meeting on the prevention and control of NCDs A/RES/66/2Doha Declaration on
NCD & Injuries
ECOSOC
2009
Global action against NCDs
2000 2007
WHO Global Status Report on
NCDs
Global Strategy for the
Prevention and Control of NCDs
WHA53.17
WHA61.14
Action Plan on the Global Strategy for the Prevention and
Control of NCDs2008-2013
Moscow Declaration
WHA64.11
WHA60.23
Implementation Global Strategy
2003
WHA56.1Global Strategy
on Diet, Physical Activity
and Health
WHA57.17Global Strategy to Reduce the
Harmful Use of Alcohol
WHA63.13 WHA63.14Marketing of
food & non-alcoholic beverages to
children
2004 201120102008
A Comprehensive global monitoring
framework
Global Action Plan 2013-2020
Options & timeline for strengthening and
facilitating multisectoral action
2013
WHA66.10
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UN High-level Meeting on NCDs (19-20 September 2011, New York)
It was only the 2nd time in history that the UN General Assembly discussed a health issue
Political Political Declaration on Declaration on
NCDs (A66/RES/2)NCDs (A66/RES/2)
113 Member States 34 Presidents & Prime-Ministers 3 Vice-Presidents & Deputy Prime-Ministers 51 Ministers of Foreign Affairs and Health 11 Heads of UN Agencies 100s of NGOs
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•Develop a global monitoring framework and targets •Develop a global implementation plan 2013-2020 •Provide technical support to developing countries •Identify options for multisectoral actions•Coordinate work with other UN Agencies •Measure results and report
Political Declaration on NCDs (A66/RES/2)Political Declaration on NCDs (A66/RES/2)
UNGA High-level Meeting on the prevention and control of NCDs
•Head quarter•WHO Regional Offices•Member states
• Establish multisectoral national plans by 2013 • Integrate NCDs into health-planning processes and the national development agenda • Promote multisectoral action through whole-of-government approaches • Set national targets and measure results • Increase domestic resources
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World Health Organization (WHO)Vision:
The promotion of equity, universal access, and self-reliance in health development
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Strategies to deliver on this vision: Health systems and capacity building NCDs, mental health & disabilities Health security Health development for poverty reduction (by accelerating MDGs) Improving access to medical products Improving performance through reform
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WHO reform: Global Programme of Work (Draft 12th)
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Rio+20 United Nations Conference on Sustainable Development [June 2012]
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“ We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and NCDs, and where populations can reach a state of physical, mental and social well-being. ” (paragraph 138) “ We acknowledge that the global burden and threat of NCDs constitutes one of the NCDs constitutes one of the major challenges major challenges for for sustainable development sustainable development in the 21st century. ” (paragraph 141)
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ndUN Task Team on
the post-2015 UN development agenda [June 2012]
“ The MDGs did not adequately address … increase in NCDs . ” (paragraph 19)
“ Priorities for social development and investments in people would include: … NCDs. Access to sufficient nutritious food and promotion of healthy life styles with universal access to preventive health services will be essential to reduce the high incidence of NCDs diseases in both developed and developing countries” (paragraph 67)
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Global Action Plan for the Prevention and Control of NCDs 2013–
2020Objectives1. To raise the priority accorded to the prevention & control of
NCDs in global, regional and national agendas and internationally agreed development goals, through strengthened international cooperation and advocacy
2. To strengthen national capacity, leadership, governance, multisectoral action and partnerships to accelerate country response for the prevention & control of NCDs
3. To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments
4. To strengthen and orient health systems to address the prevention & control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage
5. To promote and support national capacity for high-quality research and development for the prevention & control of NCDs
6. To monitor the trends and determinants of NCDs and evaluate progress in their prevention & control
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The package of low-cost "best buys" interventions exist
, but implementation in developing countries is still weak
NCDs is preventable !
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Implementing low-cost workable solutions in developing countries could prevent most
premature deaths from NCDs
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23 13/ + /
• Implementing cost-effective interventions that reduce exposure to NCDs risk factors of populations will contribute up to 2/3 of the reduction in premature mortality.
• In addition, health systems that respond more effectively and equitably to the health-care needs of people with NCDs can reduce premature mortality by another 1/3 up to 1/2.
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Population-based interventions addressing NCD risk factors: “Best buy” & “Good buy”
interventions Risk factor Best buy Good buy
Tobacco use
•Protect people from tobacco smoke•Warn about the dangers of tobacco•Enforce bans on tobacco advertising•Raise taxes on tobacco
• Offer counseling to smokers
Harmful use of alcohol
•Restrict access to retailed alcohol•Enforce bans on alcohol advertising•Raise taxes on alcohol
• Enforce drink-driving laws (breath-testing)• Offer brief advice for hazardous drinking
Unhealthy diet
•Reduce salt intake•Replace trans-fat with polyunsaturated fat•Promote public awareness about diet
•Restrict marketing of food& beverages to children Replace saturated fat with unsaturated fat•Manage food taxes & subsidies•Offer counseling in primary care•Provide health education in worksites•Promote healthy eating in schools
Physical inactivity
•Promote physical activity (mass media)
•Promote physical activity (communities)•Support active transport strategies•Offer counseling in primary care•Promote physical activity in worksites•Promote physical activity in schools
Infection •Prevent liver cancer via hepatitis B vaccination
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Individual-based (Health care) interventions addressing NCD risk factors: “Best buys”
Risk factor Best buy Good buy
Cardiovascular disease (CVD)& diabetes
• Counseling & multidrug therapy (including glycemic control for DM) for people (≥30 years), with 10-year risk of fatal or nonfatal cardiovascular events ≥ 30%• Aspirin therapy for acute myocardialinfarction
• Counseling & multidrug therapy (including glycemic control for DM) for people ( ≥ 30 years), with a 10-year risk of fatal and nonfatal cardiovascular events ≥ 20%
Cancer • Cervical cancer screening (VIA), & treatment of pre-cancerous lesions to prevent cervical cancer
•Breast cancer – treatment of stage I•Breast cancer – early case-finding through biennial mammographic screening (50–70 years) & treatment of all stages•Colorectal cancer-screening at age 50 and treatment•Oral cancer – early detection and treatment
Respiratorydisease
• Treatment of persistent asthma with inhaled corticosteroids and beta-2 agonistsEarly detection & care, using cost-effective & sustainable health-care
interventions>> integrate into primary health care
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Orratai Waleewong, B.Pharm, MScHealth Promotion Policy Research Center (HPR)
International Health Policy Program (IHPP) [email protected]