Faculty of Medicine - PowerPoint Presentation

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Faculty of Medicine Public Health (31505291)الصحة العامةLecture 15 Global overview of Non-Communicable Diseases (NCDs)

By Hatim JaberMD MPH JBCM PhD25-7-2018

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The global health impact of mental health and mental diseases. Drug abuse and Addictive substancesGlobal overview of communicable diseases Global overview Non- Communicable Diseases(NCDs) The global health impact of Hepatitis, Tuberculosis and HIV/AIDS The global health impact of Cardiovascular Diseases , Diabetes and ObesityHealth service delivery in developing countriesHealth policy, Health prioritiesHealth systems and financing Quality of care and effectiveness in different health services systems;

Health policies and management within a global health perspectiveViolence and injuries Migration and Travelers' healthSlide3

Presentation outlineTimeIntroduction of concepts09:15

to 09:25Current trends an occurrence of global NCDs09:25 to 09:35

Current trends an occurrence of global NCDs

09: 35 to 09:40

Risk factors associated with NC global diseases.

09:40 to 09:50

Aging populations and chronic illness

09:50 to 10:15

Basic principles and policies for prevention and control at global level

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Trends in Global Deaths 2002-30Source: World Health Statistics 2007Slide5

5Classifying deaths and diseases(WHO)Communicable diseases [Group I]Those where death is directly due to the action of a communicable agentNon-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]Slide6

“Non - Communicable”With rapid urbanization, industrialization and increasing level of affluence (the so called “modernization”), the price that the society is paying is a tremendous load of “Non - Communicable” diseases, also referred to as “Chronic” diseases” and, often, as “Lifestyle Diseases”Slide7

World - wide Magnitude of the Problem :Chronic diseases represent a huge proportion of human illness. They include: cardiovascular disease (30% of projected total worldwide deaths in 2005), cancer (13%), chronic respiratory diseases (7%), anddiabetes (2%)Three risk factors underlying these conditions are key to any population - wide strategy of control – tobacco use, physical inactivity and obesity.Slide8

These risks and the diseases they engender are not the exclusive preserve of rich nations. An estimated total of 58 million deaths worldwide in a year, heart disease, stroke, cancer, and other chronic diseases will account for 35 million, more than 15 million of which will occur in people younger than 70 years. Approximately four out of five of all deaths from chronic disease now occur in low – income and middle - income countries, and the death rates are highest in middle - aged people in these countriesSlide9

Socio-Environmental Changes have Led to Increasingly Unhealthy Lifestyles in PopulationsSlide10

Non-communicable diseases are the leading killer today and are on the increase. Nearly 80% of these deaths occurred in low- and middle-income countries. 10Slide11

More than nine million of all deaths attributed to noncommunicable diseases (NCDs) occur before the age of 60.Around the world, NCDs affect women and men almost equally.Slide12

Distribution of deaths in the world by sex, 200412GBD report 2004 update, 2008Slide13

Global status report on noncommunicable diseases (April 2011 the World Health Organization (WHO) )NCDs are the leading cause of death in the world, responsible for 63% of the 57 million deaths that occurred in 2008.The majority of these deaths - 36 million - were attributed to cardiovascular diseases and diabetes, cancers and chronic respiratory diseases.13Slide14

NCDs are largely preventable by means of effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.NCDs are not only a health problem but a development challenge as well. Slide15

The leading causes of NCD deaths in 2008 were: cardiovascular diseases (17 million deaths, or 48% of NCD deaths); cancers (7.6 million, or 21% of NCD deaths); and respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), (4.2 million).Diabetes caused an additional 1.3 million deaths.Behavioral risk factors, including tobacco use, physical inactivity, and unhealthy diet, are responsible for about 80% of coronary heart disease and cerebrovascular disease.

Global status report on noncommunicable diseases (April 2011 the World Health Organization (WHO) )15Slide16

16A global problemIn 2004 there were 59 million deaths world-wideNon-communicable diseases accounted for 60% of these deaths and injuries and violence 10%. By 2020 it is estimated that non-communicable disease will account for 73% of all deathsGBD 2004 Update, 2008Slide17

17Non-communicable diseases as % of all deaths by global region (all ages)WORLDWIDE

59%

N.America

; W Europe

88%

China, W Pacific, + some SE Asia

75%

Latin America + Caribbean

67%

S E Asia including India

51%

Sub-Saharan Africa

21%Slide18

18Drivers of the epidemiological transition in low and middle income countriesPopulation ageingMajor socio-economic changes (especially urbanisation)changes in risk factors such as diet, physical activity, smoking etc.Slide19

The Increasing Burden of Chronic Non-communicable Diseases: 2008 and 2030Slide20

Prevalence of Chronic Disease and Disability among Men and Women Aged 50-74 Years in the United States, England, and Europe: 2004Slide21

The Growth of Numbers of People with Dementia in High- income Countries and Low- and Middle-income Countries: 2010-2050Slide22

Mortality rates among men and women aged 15–59 years, region and cause-of-death group, 200422GBD report 2004 update, 2008Slide23

Projected global deaths for selected causes, 2004–203023GBD report 2004 update, 2008Slide24

Noncommunicable diseases: country income24About 30% of people dying from NCDs in low- and middle-income countries are aged under 60 years and are in their most productive period of life.The prevalence of NCDs is rising rapidly and is projected to cause almost three-quarters

as many deaths as communicable, maternal, perinatal, and nutritional diseases by 2020, and to exceed them as the most common causes of death by 2030.In most middle- and high-income countries NCDs were responsible for more deaths than all other causes of death combined, with almost all high-income countries reporting the proportion of NCD deaths to total deaths to be more than 70%. Slide25

Noncommunicable diseases: Current status and trends in risk factors25Common, preventable risk factors underlie most NCDs. These risk factors are a leading cause of the death and disability burden in nearly all countries, regardless of economic development. The leading risk factor globally for mortality is:raised

blood pressure (responsible for 13% of deaths globally), followed by tobacco use (9%), raised blood glucose (6%),

physical inactivity (6%),

overweight and obesity (5%).Slide26

The list of major lifestyle diseasesSlide27

What are the major components of “Lifestyle”Lifestyle diseases or “Non-Communicable Diseases” have common risk factorsSlide28

Noncommunicable diseases: Current status and trends in risk factors28The prevalence of these risk factors varied between country income groups, with the pattern of variation differing between risk factors and with gender. High-, middle- and low-income countries had differing risk profiles. Several risk factors have the highest prevalence in

high-income countries. These include: physical inactivity among women, total fat consumption, raised total cholesterol.

Some risk factors have become more common in

middle-income

countries. These include:

tobacco use among men,

overweight and obesity.Slide29

Noncommunicable diseases:parameters for estimation of behavioral and metabolic risk factors29current daily tobacco smoking: the percentage of the population aged 15 or older who smoke tobacco on a daily basis.physical inactivity: the percentage of the population aged 15 or older engaging in less than 30 minutes of moderate activity per week or less than 20 minutes of vigorous activity three times per week, or the equivalent.

raised blood pressure: the percentage of the population aged 25 or older having systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥90 mmHg or on medication to lower blood pressure.Slide30

Noncommunicable diseases:parameters for estimation of behavioral and metabolic risk factors30raised blood glucose: the percentage of the population aged 25 or older having a fasting plasma glucose value ≥ 7.0 mmol/L (126 mg/dl) or on medication for raised blood glucose.overweight: the percentage of the population aged 20 or older having a body mass index (BMI) ≥ 25 kg/m2.

obesity: the percentage of the population aged 20 or older having a body mass index (BMI) ≥30 kg/m2.raised cholesterol: the percentage of the population aged 25 or older having a total cholesterol value ≥ 5.0 mmol/L (190 mg/dl).Slide31

Prevention of noncommunicable diseases: a global PERSPECTIVESlide32

Noncommunicable diseases: Prevention and Control of NCDs32Millions of deaths can be prevented by stronger implementation of measures that exist today. These include policies that promote government-wide action against NCDs: stronger anti-tobacco controls promoting healthier diets, physical activity,

reducing harmful use of alcohol; along with improving people's access to essential health care.Slide33

Noncommunicable diseases:The six objectives of the 2008-2013 Action Plan are:33To raise the priority accorded to noncommunicable disease in development work at global and national levels, and to integrate prevention and control of such diseases into policies across all government departmentsTo establish and strengthen national policies and plans for the

revention and control of noncommunicable diseasesTo promote interventions to reduce the main shared modifiable risk factors for noncommunicable diseases : tobacco use, unhealthy diets, physical inactivity and harmful use of alcoholSlide34

Noncommunicable diseases:The six objectives of the 2008-2013 Action Plan are:34To promote research for the prevention and control of noncommunicable diseasesTo promote partnerships for the prevention and control of noncommunicable diseasesTo monitor noncommunicable

diseases and their determinantsEvaluate progress at the national, regional and global levelsSlide35

First global ministerial conference on healthy lifestyles and noncommunicable disease control28-29 April 2011, Moscow, the

Russian Federation35

The

aim

of

the

conference was to support Member States develop and strengthen

policies

and

programmes

on

healthy

lifestyles

and

NCD

prevention

.

The

conference

ha

d

three

main

goals

:

to

highlight

the

magnitude

and

socio-economic

impact

of

NCDs; to review international experience on NCD prevention and control; to provide evidence on the pressing need to strengthen global and national initiatives to prevent NCDs as part of national health plans and sustainable development frameworksSlide36

What are the main noncommunicable diseases?Heart disease and stroke

Diabetes

Cancer

Chronic respiratory diseaseSlide37

NCDs and risk factors

“Lifestyle diseases” caused by “behaviors”Slide38

Why is tackling NCDs a priority?

"Among both men and women, most deaths globally are due to noncommunicable conditions"

Out of every 10 deaths:

6 are due to noncommunicable conditions

3

to communicable, reproductive

or nutritional conditions

1 is due to injuriesSlide39

Source: WHO Global Health Estimates 2014 (Year: 2012), Deaths by age groupNCD deaths as a proportion of all deaths, 2012

NCDs and nutritional conditions

Infectious and parasitic diseases, respiratory infections

Maternal and neonatal conditions

Injuries

Ages 0 – 29

11 million deaths

2 million NCD deaths

Ages 30 – 69

20 million deaths

14 million NCD deaths

Ages 70+

25 million deaths

22 million NCD deaths

Largely preventable deathsSlide40

Deaths from NCDs before the age of 70 as a percentage of total deaths from NCDsSource: WHO Global Health Estimates 2014 (Year: 2012), Deaths by age groupThe proportion of people who die prematurely from NCDsis highest in poorest countries

NCDs are not a "rich country" problem Slide41

NCDs included in the 2030 Agenda for Sustainable DevelopmentSlide42

“We acknowledge that the global burden and threat of NCDs constitutes one of the major challenges for sustainable development in the twenty-first century ” (paragraph 141)

Why are NCDs relevant to SDGs?

Rio+20: The SDGs can only be achieved in the absence of NCDsSlide43

60

50

40

30

20

10

0

Catastrophic

expenditures

Impoverishment

Cancer

No cancer

percentage

Why are NCDs relevant to development?

NCDs lead to impoverishment from long-term treatment and care costs

NCDs lead to high burden of disease, low quality of life and lost human potentialSlide44

NCDs in SDG 3 “Ensure healthy lives and promote well-being for all at all ages”Target 3.3 By 2030, end the epidemics of HIV, TB and malaria3 Target 3.4 By 2030, reduce by one third premature mortality from NCDs and promote mental health and well-being Target 3.5 Strengthen the prevention and treatment of substance abuse, including harmful use of alcohol Target 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents Target 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all Target 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination Target 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate

Target 3.b Support the research and development of vaccines and medicines for the…NCDs that primarily affect developing countries Slide45

By 2030:Target 3.4: Reduce by one third premature mortality from NCDs by prevention, treatment and promoting mental health and well-being Target 3.a: Implement the WHO tobacco treatyTarget 3.5: Reduce the harmful use of

alcohol

2030 Agenda for Sustainable DevelopmentSlide46

Guidance provided by the WHO Global NCD Action Plan 2013-2020

Vision:

A world free of the avoidable burden of NCDs

Goal:

To reduce the

preventable and avoidable burden of morbidity, mortality and disability due to NCDs by

means of multisectoral collaboration and cooperation at national, regional and global levelsSlide47

Best buysTobacco

Reduce affordability of tobacco products by increasing tobacco excise taxesCreate by law completely smoke-free environments in all indoor workplaces, public places and public transport

Warn people of the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns

Ban all forms of tobacco advertising, promotion and sponsorship

Harmful use of alcohol

Regulate commercial and public availability

of alcohol

Restrict or ban alcohol advertising and promotions

Use pricing policies such as excise tax increases on alcoholic beverages

WHO Global NCD Action Plan 2013-2020Slide48

Best buysDiet and physical activityReduce salt intake

Replace trans fats with polyunsaturated fatsImplement public awareness programmes on diet and physical activityPromote and protect breastfeeding

Cardiovascular

diseases and diabetes

Drug therapy

and counselling to individuals who have had a heart attack or stroke and to persons with high risk of a cardiovascular event in the next 10 years

Acetylsalicylic acid (aspirin) for people at risk of suffering an acute myocardial infarction (heart attack)

Cancer

Prevention of liver cancer through hepatitis B immunization

Prevention of cervical cancer through screening

and

timely treatment of pre-cancerous lesions

WHO Global NCD Action Plan 2013-2020Slide49

1

2

3

4

Adoption of national NCD targets and indicators

Mortality data

Risk factor surveys

National integrated NCD strategy/action plan

5

Tobacco demand-reduction measures

taxation



smoke-free policies



health

warnings



advertising bans

10 Progress Monitoring IndicatorsSlide50

6

7

8

9

10

10 Progress Monitoring Indicators

Harmful use of alcohol reduction measures

availability regulations

 advertising and promotion bans  pricing policies

Unhealthy diet reduction measures

salt/sodium policies

 saturated fatty acids and trans-fats policies  marketing to children restrictions  marketing of breast-milk substitutes restrictions

Public awareness on diet/physical activity

Guidelines for the management of major NCDs

Drug therapy/counselling for high-risk personsSlide51

The Global Strategy on Diet, Physical Activity and Health (DPAS) implementation toolkit includes:A Framework to monitor and evaluate implementationGlobal recommendations on physical activity for healthGuide for population-based approaches to increasing levels of physical activityRecommendations on the marketing of food and non-alcoholic beverages to childrenPopulation-based prevention strategies for childhood obesityReducing salt intake in populationsSchool policy frameworkPreventing noncommunicable diseases in the workplace

http://www.who.int/dietphysicalactivity/implementation/toolbox/en/

Global Strategy on Diet, Physical Activity and HealthSlide52

WHO Toolkit on Salt ReductionSlide53

WHO Commission on Ending Childhood Obesity

who.int/end-childhood-obesity/final-reportSlide54

WHO brings diabetes into the public eyehttp://www.who.int/campaigns/world-health-day/2016/en

World Health Day - 22 March 2016Slide55

3.3 million deaths globally are attributable to alcohol consumption (5.9% of deaths, all age groups)5.1% of the global burden of disease is attributable to alcohol consumption

(139 million DALYs)Global Burden of Disease 2012 (WHO, 2014))

Evidence on alcohol and health

Properties

of ethanol

:

Psychoactive and intoxicating

Toxic with high mortality in

overdoses

Carcinogenic

Dependence-producingSlide56

56% of deaths aged 35-69 years attributable to smoking in 2000

Men

Women

Belarus

33%

0%

Russia

33%

3%

Ukraine

32%

3%

Central Asia (8)

23%

4%

Estonia

31%

3%

Latvia

30%

2%

Lithuania

29%

0%

United Kingdom

25%

21%

Germany

29%

11%

Source :

http://www.deathsfromsmoking.net/Slide57

57Risk of myocardial infarction increases with every single cigarette smoked per dayNumber of cigarettes smoked per dayOdds Ratio of Myocardial Infarction

Never 1-2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19-20 >=21Source : K. K. Teo et al Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART studyLancet 368 (9536):647-658, 2006.

INTERHEART study 52 countries 12 461 cases, 14 637 controlsSlide58

Pseudo science

"medical science"

"nationwide survey"

"three outstanding independent research organisations"

"T-zone test"

"Doctors"

"a longer, healthier life … thank your doctor for that"Slide59

Tobacco as a crop

Tobacco is a labour-intensive cash cropChild labour is common

Green tobacco sickness

Effects on unborn babies

N

on-smoking

tobacco

harvesters show

similar cotinine and nicotine levels to active smokers in the general populationNM Schmitt et al,

Health risks in tobacco farm workers—a review of the

literature,

Journal of Public Health, August 2007, Vol

. 15, Issue 4, pp 255–264Slide60

60

Tobacco industry is global and monolithic

The

globalization of

the

tobacco

epidemic is

facilitated

by:

T

rade liberalization

Foreign direct investment

Transnational

tobacco advertising,

promotion and sponsorship

Slide61

Regulation vs attitude changeLaws are not as popular as free choiceHow do we encourage people to choose health?

CHALLENGESlide62

WHO engagement beyond Member StatesWHO engages with non-State actors such as:- NGOs- Private sector entities- Philanthropic foundations Academic institutions Well-known persons as ambassadorswhile protecting itself from potential reputational risks, conflicts of interest, and undue influence from external actors. WHO publishes a register of NGOs in official relations with WHOSlide63

Some non-communicable diseases have infectious aetiology63Slide64

Trends in stomach cancer mortality64Source : WHO HFA databaseAge standardised mortality per 100,000Slide65

65Helicobacter pylori bacterium - a causal factor for stomach cancerSlide66

SummaryNon-communicable diseases are now the most common cause of death world wideIncreasing rates in low and middle income countries because of change in lifestyles (urbanisation)Key risk factors have very large effectsInterventions are effective and can reduce burdenThe need to combine results and have large studies66