Seminar ncd


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Seminar ncd

  1. 1. CHRONIC NON-COMMUNICABLE DISEASES1. INTRODUCTION Chronic non-communicable diseases refers to many conditions which arechronic, lifestyle related and are likely to continue progressively unless intervened.Cardiovascular diseases, stroke, diabetes, cancer, and chronic respiratory diseasesaccounted for 80% of all deaths due to non-communicable diseases 1. Mentaldisorders ca0075se a significant morbidity burden. The prevalence ofnon-communicable diseases and the resulting number of related deaths areexpected to increase substantially in the future particularly in low and middle incomecountries due to population growth, ageing in conjunction with economic transition,changes in behavioural, occupational and environmental risk factors. The growingpopulation and their increased life expectancy compete intensely for the scarceresources and reflected in the basic indicators of the country1. The global burden ofnon-communicable diseases continues to grow; tackling it constitutes one of themajor challenges for development in the twenty-first century.22. DEFINITION According to WHO (2011) “Chronic disease is an impairment of bodilystructure or function that necessitates a modification of the patient’s normallife and has persisted over an extended period of time.” “Chronic diseases as comprise all impairments or deviations fromnormal, which have one or more of the following characteristics: Permanent,Leave residual disability, caused by non reversible pathological alteration, Itrequires special training of the patient for rehabilitation ,Maybe expected torequire a long period of supervision, observation or care” 3 (The commission on chronic illness in USA -1951) A non-communicable disease, or NCD, is a medical condition or diseasewhich by definition is non-infectious and non-transmissible between persons. NCDsmay be chronic diseases of long duration and slow progression, or they may result inmore rapid death. (WHO-2011) 3. MAGNITUDE OF THE PROBLEM3.1 Disease Burden  As per the records of World Health Organization (WHO), 57 million people deaths that occurred in the world in 2008, 36 million (63%) were the result of NCDs.1 Four-fifths of these deaths were low, in middle-income countries, and 29% of those deaths were in people under 60 years, compared with 13% in high-income countries. Without intervention, deaths from NCD are set to increase by 15% between 2010 and 2020, according to WHO predictions, with the biggest increases occurring in the African, Eastern Mediterranean and South East Asian regions.1  NCDs account for more than two fifth (43 per cent) of the DALYs(Disability-Adjusted Life-Years) and among this group cardiovascular diseases, diabetes and cancer together accounted for 40 per cent of the NCD related DALYs in India.4,,5,6 1
  2. 2. 3.2 Socio Economic Burden In India, the economic impact of deaths due to cardiovascular diseases,stroke and diabetes were estimated at 8.7 billion dollars in 2005, with a projectedrise of 54 billion dollars by 2015.1 In India, the estimated annual income loss onaccount of NCD was 258 billion to 1 trillion in 2004. Of this, 32% was attributable tocardiovascular diseases, 18% to chronic respiratory diseases and 15% to diabetes. Itis believed that non-communicable diseases (NCDs) are completely eliminated; theestimated GDP (Gross Domestic Product) in a year would have been 4-10 per centhigher2.4. GAPS IN NATURAL HISTORYThere are many gaps in our knowledge about the natural history of chronic diseases.These gaps cause difficulties in aetiological investigations and research. Those are:3  Absence of known Agent: In most of NCDs the cause is not known.  Multifactorial Causation: There will be many causes, in absence of causative agents, risk factors are studied as follows: An attribute or exposure that is significantly associated with development of disease. If determinant is modified by intervention, it reduces possibility of occurrence of disease. Risk factors can be causative, contributory or predictive. They can be modifiable or non modifiable They can be individual or community risk factors Epidemiological studies are needed to identify risk factors  Long Latent Period: It is the period between the first exposure to suspected cause and the eventual development of disease. This makes difficult to link suspected causes with outcomes.  Indefinite onset of the Disease: Most NCD are slow in onset and development. Distinction between diseased and non-diseased may be difficult to establish.5. MAJOR CHRONIC NON-COMMUNICABLE DISEASESAs per WHO (World Health Organization) Working Group, the following diseaseconditions are the major chronic non-communicable diseases.7  Diabetes Mellitus  Cardio-Vascular Diseases  Cancer  Stroke  Chronic Respiratory Diseases (CRD)  Mental and Behavioural Disorders5.1 DIABETES MELLITUS It is a chronic disorder characterized by raised blood sugar levels that occurwhen the pancreas does not produce enough insulin or when the body cannoteffectively use the insulin it produces. Uncontrolled diabetes may lead to seriousdamage to many of the bodys systems, especially the nerves and blood vessels.3 2
  3. 3. 5.1.1 Magnitude of the Problem  Disease Burden The number of diabetics in India is expected to increase from 51 million in 2010 to 87 million by2030.8 Currently 39.5 million people in India have pre diabetes, and of them, seven million people will develop diabetes every year.9 Epidemiological studies indicate that the prevalence of diabetes is higher in urban India, and is increasing faster as compared to the rural population.  Socio Economic Burden An individual with diabetes may spend around twice as much on medical care compared to a contemporary individual without diabetes. While the mean direct annual cost for outpatient care for all patients with diabetes in India was Rs 4724/-, those without complications had an 18% lower cost.5 Being diagnosed with diabetes is traumatizing and imposes a long term psychological burden on the individual and the family. Complications from diabetes, such as diabetic neuropathy, amputations, renal failure and blindness are the major causes of disability.5.2 CARDIO-VASCULAR DISEASESCardio Vascular Diseases (CVDs) are a group of disorders of the heart and blood vessels, it includes the following: 10 a) Coronary Heart Disease (CHD) b) Cerebro Vascular Disease c) Peripheral Arterial Disease d) Rheumatic Heart Disease e) Congenital Heart Disease f) Deep Vein Thrombosis and Pulmonary Embolism Here, we will deal exclusively with Coronary Heart Disease (CHD), the most important cause of deaths among cardiovascular diseases. 5.2.1 CORONARY HEART DISEASE (CHD) Coronary Heart Disease is a disease of blood vessels in which arteries that provide blood and oxygen to the heart muscles are get narrowed or even completely blocked that leads to heart attacks.3 Magnitude of the Problem  Disease Burden  Coronary Heart Disease is the leading cause of death in India, accounted 2.25 million deaths in 2010 (excluding stroke) and is projected to reach 2.94 million deaths in 2015 5,11  Socio-economic burden India is estimated to have lost 8.7 billion dollars in 2017 because of Coronary heart disease.5 3
  4. 4. 5.3 CANCER Cancer is a term used for disease in which cells of the body grows and divide in an uncontrolled manner to produce abnormal cells. These cancer cells invade adjoining parts of the body and may spread to other organs. This process of spread to distant organs is called metastasis which is a major cause of death in cancer. Cancer can affect any part of the body. Cancer is also known as malignancies and neoplasms.1, 3 5.3.1 Magnitude of the Problem  Disease Burden Cancer is one of the leading causes of death among adults in India, annually accounting for about 9, 49,000 new cases and 6, 34,000 deaths in 2010. 12  Socio Economic Burden Males with cancer are likely to have a 43.9% greater likelihood of imposing catastrophic expenses on their households and a 24% greater likelihood of impoverishing their households than matched counterparts without cancer. They also use more health care services in both the public and the private sectors. Females with cancer also report higher health care use, health spending, and risks of impoverishing their households than their matched counterparts.2 5.4 STROKE A stroke is caused by the interruption of the blood supply to the brain, usually blood vessels may rupture or blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissues. A Transient Ischemic Attack (TIA) is a transient episode of loss of brain function caused by blockage of blood flow in the arteries of the brain. The symptoms of TIA improve within 24 hours.3 5.4.1 Magnitude of the Problem  Disease Burden Strokes are estimated to have caused 1.45 million cases in India during 2010 with projected increase to 1.67 million cases in 201513. The average age of stroke patients in India is seen to be less than that in developed countries and affects the most productive part of their life. Many of the stroke patients are left with permanent disability. Common disabilities include pain, stiffness, depression, memory loss, and difficulty in speaking and understanding.  Socio Economic Burden India is estimated to have lost 8.7 billion dollars in 2005 because of stroke and projected to lose 54.0 billion dollars in 2015 due to this disease.5, 13.5.6 CHRONIC RESPIRATORY DISEASES (CRD) Chronic respiratory diseases (CRD) include a large number of chronic diseases of the lungs and respiratory systems. The most common Chronic Respiratory Disease which causes an enormous health burden is chronic obstructive pulmonary disease (COPD). COPD is a continuously progressive disease which leads to marked breathing disability ultimately resulting in premature deaths. 14 4
  5. 5. 5.6.1 Magnitude of the problem  Disease Burden  According to the Million Deaths Study (2001-2003), the chronic respiratory diseases were the second commonest cause of death in Indians in the age group of 25-69 years, after cardiovascular diseases15.  The Disability Adjusted Life Years (DALY) lost due to Chronic respiratory diseases (CRDs) was estimated as 3% of 291 million for all NCDs, i.e. around 8.7 million DALYs in 200516.  Socio Economic Burden  The annual cost of treatment of COPD has been estimated to be over Rs. 35,000 crores for the year 2011 and over Rs. 48,000 crores for 201617.  Psychological and economic burden is imposed on the families due to progressive disease disability, frequent exacerbations and hospitalizations.  COPD in children poses psychological stress for themselves as well as their parents and results in poor educational performance. 5.7 MENTAL AND BEHAVIOURAL DISORDERS Mental and behavioural disorders are conditions that lead to disturbances in thinking, feeling, emotions, reactions, intelligence, judgment, decision making and behaviour. The presence of these disorders can impair a persons ability to deal with ordinary demands of the life. These conditions are varied in nature and intensity, ranging from minor disorders such as anxiety, depression, simple phobias, and substance abuse such as alcohol, tobacco to severe forms of illness like as schizophrenia, mood disorders and severe mental retardation. The disorders may also be specific to certain age groups (children & elderly) and with specific reference to some situations (aftermath of disasters).18 5.7.1 Magnitude of the Problem  Disease Burden  As per WHO, the global prevalence of mental and behavioural disorders are estimated to be about 10% and they constitute four of the 10 leading causes of disability (15% of DALYs lost) with one in four families suffering the burden.1  About 1, 50,000 deaths are estimated to occur due to suicides in India every year. Apart from greater vulnerability and socio-cultural attitudes, people from lower income levels also do not have access to quality mental health care. The age group of 15-49 years are affected with most mental disorders except those disorders specific to pediatric and geriatric age groups.19, 20  Socio-Economic Burden  Apart from direct costs of travel, medication, hospital visits and rehabilitation, the indirect productivity losses due to mental disorders are more significant.  Mental disorders cause significant amount of disabilities in the affected, which affect their education, occupation, married life, social and recreation activities and interfere in productivity and quality of life 21. 5
  6. 6. Selected Mental Health, Neurological and Behavioural Disorders: All India estimatesfor the year 2010 shown in figure-1 216. OTHER CHRONIC NON COMMUNICABLE DISEASES INCLUDE 23,07  Chronic Kidney Disease  Hearing Loss  Congenital Diseases  Autism Spectrum Disorders (ASD)  Iodine Deficiency Disorders  Fluorosis  Oro-Dental Diseases  Hereditary Blood Disorders  Injuries  Burns  Dementia  Epilepsy  Musculo Skeletal Disorders  Geriatric Disorders  Disasters7. RISK FACTORS The underlying socio-economic, cultural, political and environmentaldeterminants for NCDs include Globalization, Urbanization and Population ageing.The risk factors for NCDs are classified in terms of their amenability to interventionsas modifiable risk factors, non-modifiable risk factors and intermediate risk factors. 3,47.1 Modifiable Risk Factors Tobacco Use Tobacco consumed in any form, whether smoked or chewed and second-handtobacco smoke exposures are associated with adverse health effects. It isassociated with cardiovascular diseases, cancers, chronic respiratory disease, andother communicable and non communicable diseases. Alcohol Consumption There is a direct relationship between higher levels of alcohol consumption andrising risk of cardiovascular diseases and some liver diseases. Heavy episodicdrinking (binge drinking) is especially associated with cardiovascular diseases. 6
  7. 7.  Consumption of Fruits, Vegetables and Processed Food Inadequate consumption of fruits and vegetables (less than five servings /day)increases the risk for cardiovascular diseases, stomach cancer and colorectalcancer. The consumption of high levels of high-energy foods, such as processedfoods that are high in fats and sugars, promotes obesity. Consumption of > 5 gram ofdietary salt/ day predisposes to higher blood pressure levels and increased risk ofcardiovascular diseases. Consumption of high amounts of saturated fats and transfatincreases the risk of coronary heart disease and diabetes. Physical Inactivity Low physical activity is an important cause of overweight and obesity.Participation in 150 minutes of moderate physical activity for every week orequivalent activity is estimated to reduce the risk of cardiovascular disease,diabetes, breast and colon cancer, and depression. Poverty Poverty means that there is less purchasing power in the homes. This lowpurchasing power results in compromising on the choices that is made at thehousehold level. This results in major health-damaging behaviors such as tobaccouse, harmful use of alcohol, inadequate consumption of fruits and vegetables andpreferential use of less expensive and unhealthy foods among the vulnerable andmarginalized groups of people. Environment Environmental risk factors are contributing to the NCD’s’ like as Air Pollution,water Pollution, Occupational Hazards and Exposure to Radiation. Inadequate Health Services Failure and inability to obtain preventive health services such as screening,regular follow up are major predisposing factors to the NCDs. Also, some latediagnosis of disease conditions, untreated infections may lead to carcinomas. Stress Factors Acute and chronic stresses such as Homelessness, Stressful work conditionsand Situations as in Natural and Manmade Disasters are major causes for manyphysiological and psychological disorders.7.2 Non modifiable risk factorsThe Risk factors, which cannot be modified are called as non-modifiable risk factors,as follows: Age: Elderly and children are the vulnerable group to get the diseases basically. Sex: There will be some difference between the disease ratios among the gender. Family History of Genetic Factors: Genetic factors are major risk factors which cannot be modified. Personality: Individual personality may contribute in development of the non communicable diseases.7.3 Intermediate Risk Factors  Obesity and Overweight (overweight (BMI>=25) or Obese (BMI>=30)) Physical inactivity and inappropriate nutrition are directly reflected in thegrowing burden of overweight in the Indian population predominantly in the urbanareas. Central obesity is an important risk factor for diabetes and appears to betterpredict the risk of diabetes among Indians in Asian region. 7
  8. 8.  Hyperlipidemias(>200 mg/dl) People with hyperlipidemias (most often high cholesterol) are at increased riskof ischemic heart diseases, stroke, and other vascular diseases.  Raised blood Pressure (>120/80 mmhg) Raised blood pressure is considered as modern life style disorder in thepresent scenario. It is a major risk factor for cardiovascular diseases.  Raised Blood Glucose(>120 mg/dl) Raised blood glucose increases the propensity to macro vascular and microvascular complications, such as cardiovascular diseases, cerebro vascular disease,retinopathy, nephropathy, neuropathy and diabetic foot, all of which account forconsiderable mortality and morbidity8. IMPACT ON ECONOMIES, HEALTH SYSTEMS, HOUSEHOLDS ANDINDIVIDUALS The impact of the mounting NCD challenge cannot be fully understood without considering the broad range of direct and indirect effects on economies and health systems, as well as on the affected individual and his or her household. These effects, in aggregate, drive economic and human development outcomes including the decreased country productivity and competitiveness, greater fiscal pressures, diminished health outcomes, increased poverty and inequity, and reduced opportunities for society, households and individuals 2,5,14Impact on Economies Reduced labor supply and outputs Additional costs to employers Lower returns on human capital investments Lower tax revenues Increased public health and social welfare expendituresImpact on Health systems Increased consumption of NCD-related healthcare High medical treatment costs (per episode and over time) Demand for more effective treatments (e.g., cost of technology and innovation) Health system adaptation and costs. (e.g., organization, service delivery, financing)Impact on Households and Individuals Reduced well-being Increased disabilities Premature deaths Household income decreases, or impoverishment, Savings and assets loss Higher health expenditures, including catastrophic spending9. PREVENTION OF NON-COMMUNICABLE DISEASES Prevention of NCDs can be done through following method 3,11  Primordial prevention: Through the prevention of emergence or development of risk factors in the population or in the countries in which they have not yet appeared. Efforts are directed towards discouraging children from adopting harmful life styles. 8
  9. 9.  Primary prevention: Action taken prior to the onset of disease which removes the possibility that the disease will ever occur. Effort will be done through health promotion and specific protection  Secondary prevention: Action which halts the progress of the disease at its incipient stage and prevents complications.  Tertiary prevention: All measures available to reduce impairments and disabilities minimize suffering due to departure from good health and promote patient’s adjustment to irremediable conditions. Effort will be done through disability limitations and rehabilitation10. GLOBAL AND NATIONAL EFFORTS TOWARDS “NCD” CONTROLIN INDIA10.1 Innovation to Counter NCD. The World Health Assembly held in the month of May 2012 set a global targetto reduce deaths under 70 years of age due to NCD by 25% before 2025. Innovationwill be essential to achieve this target; the innovations may act on the biological riskfactors of NCD such as hypertension, high blood sugar, high blood lipids andobesity, on the behavioural risk factors like as tobacco, poor diet, physical inactivityand the harmful use of alcohol or on the social determinants of NCD. The types ofinnovation WHO identified are: biological and information technology, medicaldevices, changes in the workforce, greater involvement of patient’s and civil societyand organizational innovations. 2210.2 Drivers of Innovation Diffusion To have impact, innovations must diffuse widely, but within health systemsthey all too often do not diffuse.Drivers of diffusion include: Professional discussion by stakeholders like market,consumers, government, international organizations and business.However, there are some barriers, those are:  Existing healthcare providers and professional hierarchies might resist changes that threaten their dominance and income  Fears that innovations will not be safe and the risk that financial benefits from the innovation might occur in a different budget from that of the costs, and might take some years to become visible and be appreciated. India has shown its commitment to prevention and control of NCDs. India wasamong the first signatories to the Framework Convention for Tobacco Control(FCTC) and has endorsed the Global Strategy on Diet, Physical Activity and Health.The Government of India has implemented legislations and policies in accordancewith the FCTC.2210.3 Ongoing National Programmes for prevention & Control of NonCommunicable Diseases: Government of India had supported the States in Prevention and Control of NCDs through several vertical programmes. They are as follows: 23  National Cancer Control Program (1975)  National Blindness Control Program (1976) 9
  10. 10.  National Mental Health Program (1982)  National Iodine Deficiency Disorders Control Program (1986)  National Tobacco Control Program (2007) th  Trauma Care Facility on National Highways(9 Plan)  National Deafness Control Program (2006-07)  National Program for Prevention and Control of Fluorosis (2007-08)  Pilot Project on Oral Health (2007-08)  National Program for Prevention & Control of Cancer, Diabetes, cardiovascular diseases (CVD) and Stroke (2010-11)  National Program for Health Care of the Elderly (2010-11)  Pilot Program for Prevention of Burn injuries (2010-11)  Up gradation of Department of Physical Medicine & Rehabilitation (PMR) in Medical Colleges (2010-11)  Disaster Management/Mobile Hospitals (2010-11)  Organ and Tissue Transplant biomaterial centers (2010-11)11. WHO BEST BUYS FOR CONTROL OF NON-COMMUNICABLEDISEASES  World Health Organization has led global efforts to address NCDs through development of different instruments. Those are Population level interventions and Individual Level Interventions.7,23,2411.1 Population level Interventions NCDs can best be addressed by a combination of primary prevention, targetingwhole population, by measures that targeting high-risk individuals and by improvedaccess to essential health-care interventions for people with NCDs.  Enforcing bans on tobacco advertising, promotion and sponsorship.  Raising taxes on tobacco.  Strong legislative effort for tobacco control: Government of India had ratified the National Anti-Tobacco Legislation in 2007, which bans smoking in public places throughout the country.  Restricting access to retailed alcohol.  Enforcing bans on alcohol advertising.  Raising taxes on alcohol.  Promoting salt reduction in the community through awareness generation and reducing salt content of processed foods.  Regulatory mechanism for fruits and vegetable prices.  Promoting public awareness about diet (Replacing trans-fat in food with polyunsaturated fat) and physical activity, through mass media.  Comprehensive policies on food production, nutrition, marketing, and transport to promote primordial prevention of CVDs. (Cardio-vascular diseases)  Modifying the environment (building the play grounds & parks for relaxation).  Promoting use of cleaner alternate fuels in kitchens.  Improved monitoring and strict enforcement of air quality norms in urban as well as rural areas.  Public education on air-quality and measures to reduce air pollution.  Developing alternative financing models that protect citizens from the catastrophic financial impact of chronic diseases including CVDs.(Cardio- vascular diseases) 10
  11. 11.  A major initiative in CVD control has been the launch of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke [NPCDCS) in 2010. This envisages early diagnosis, risk reduction, and appropriate management of these diseases at primary health care level.  Protection from occupational carcinogens  Protection against HBV( Hepatitis B virus) and HPV (Human papilloma virus) by vaccination The National Cancer Control Programme was revised in 1984. This programme hasnow been integrated into the National Programme for Prevention and Control ofCancer, Cardiovascular Diseases, Diabetes and Stroke since 2011. The data oncancer is collected by hospital and population based cancer registries, collated andpublished by the National Cancer Registry Programme (NCRP) of the Indian Councilof Medical Research (ICMR).11.2 Individual Level Interventions  Screening and early diagnosis of disease in all health care settings  Individual health education towards prevention of diseases and promotion of health.  Counselling, drug therapy, specific treatment and rehabilitations.12.STRENGTHENING HEALTH SYSTEMS TOWARDS NCDs IN INDIA23  Development and implementation of clinical practice guidelines and standards at different levels of health care centre.  Adequate supply of drugs at all health care centre  Providing better counseling services for lifestyle changes including cessation of tobacco use and Public education about diabetes and its complications.  A multi-sectoral approach beyond the health sector is required to curb the diabetes epidemic, for example, labeling of food items with nutrition facts, making healthy food options available at schools and workplaces, compulsory physical activities in educational institutes.  Training of primary health care staff in management of chronic respiratory diseases.  Cancer awareness and screening for cervical, breast and oral cancer should be introduced at the primary health care level in the National Rural Health Mission (NRHM).  Diagnostic and management facilities for above said cancers should be introduced at the district level.  Specialized treatment services for cancers in medical colleges and other hospitals.  Home support for palliative and rehabilitative services should be introduced at the primary health care level.  Training of doctors and nurses to identify and manage all kind of diseases  Establishment of vascular (cardiac and stroke] units at district level and medical college hospitals.  Establishment of ambulance and referral systems.  Greater investment in infrastructure and manpower to improve capacity for prevention and control of NCDs.  Accreditation to improve quality of care at different levels, including private sectors. 11
  12. 12. 12.1 National Effort towards Mental Health Problems24  Policy & Health System Interventions Revised District Mental Health Programme incorporating public health approaches to cover all districts Implementation of the revised Mental Health Care Act to facilitate rights of the mentally ill along with strengthening of implementation Capacity building of policy makers and programme managers to enhance mental health care delivery, implementation, monitoring and evaluation Human resource development with training of doctors, health care workers and peripheral workers Expanding the role of mental hospitals and medical college psychiatry units to integrate preventive, curative, promotive and rehabilitative services along with manpower development and research Strengthening educational and employment opportunities for those who have recovered from mental disorders Integrating mental health with other activities in health sector with AYUSH systems of medicine, and other related sectors Involvement of NGOs in stigma reduction, rehabilitation, public awareness building and advocacy issues. India has a National Mental Health Programme for more than 25 years withcurative, preventive, promotive and rehabilitative components covering policy andprogramme issues. The programme is at present being implemented across 100districts and is likely to be expanded to the entire country during 2012-17.13. SPECIFIC ACTIONS BY DIFFERENT STAKEHOLDERS There are some specific actions to be performed by the stakeholders in thesociety to prevent and control of NCDs.7 Government a. Revision of National Health Policy to address NCDs or formulate a NCD Policy. b. Setting-up an Inter-Ministerial Group or Group of Ministers to address critical inter-sectoral issues (urban development, road transport, agriculture, food processing, finance, human resource development, information and broadcasting, industry, trade & commerce, communications) c. Assessing health impact of all major developmental programmes d. Adopting regulatory and fiscal measures to influence dietary behaviour (regulation of sugar, salt and transfat in food products) tobacco and alcohol use e. Creating a National Health Promotion Foundation to co-ordinate and catalyze all activities related to NCDsIndividuals a. Adopting healthy lifestyle and motivating others to do so. b. Being an aware and responsible citizen - following regulations and insisting others also to do so c. Monitoring and changing the behaviour of children (watching TV, diet, physical activity) in the family. 12
  13. 13. Communities/Schools/Workplaces a. Creating an healthy environment for adoption of healthy behavior b. Supporting implementation of regulations c. Creating and maintain facilities for physical activity / healthy diets d. Incentivizing good behaviours and disincentives the inappropriate behaviors.Health Professionals a) Taking leadership role at individual level as well as community level to advocate lifestyle changes b) Developing / implementing guidelines for prevention and management of NCDs c) Strengthening the capacity of health workforce to address NCDs d) Conducting appropriate epidemiological, operational and translational research to address NCDs.Non Governmental Organizations a) Mobilizing the community to adopt Healthy Lifestyles b) Change the societal "norms" c) Being a watchdog and monitor implementation of regulations.14. PLAN OF ACTION TO PREVENT AND CONTROL OF NCDS DURING12th PLAN A comprehensive approach would be required for both prevention and management of NCDs in the country. It is proposed to continue ongoing efforts and introduce additional programmes to cover important NCDs for public health importance through following key points7,2414.1 KEY COMPONENTS OF NCD PREVENTION AND CONTROL PROGRAMMESINCLUDE: Formulation and implementation of comprehensive policies and programmes to address NCDs. Strengthening of health system in terms of human resource availability, development of standard management guidelines, training at all levels of human resources, ensuring availability of drugs and equipments. The role of private sector is also important in this regard. As NCDs require lifelong treatment and often require costly health care interventions, a sustainable and equity-based health financing system needs to be set up. This is required to ensure universal coverage for prevention and control of NCDs. Currently, the surveillance efforts and information system in the country are disjointed, ad-hoc and inadequate. There is an urgent need to bring them under a common umbrella and integrate it with ongoing disease surveillance systems.14.2 IMPLEMENTATION To ensure long term sustainability of interventions, the programmes wouldbe built within existing public sector health system and wherever feasible introducepublic private partnership models. Following will be major components of NCDprogrammes: 13
  14. 14.  Primary Health Care includes Health promotion, screening , basic medical care, home based care & referral system (to be integrated with NRHM- National Rural Health Mission)  Strengthening District Hospitals for diagnosis and management of NCDs including rehabilitation and palliative care, NCD Clinic, Intensive Care Unit, District Cancer Centre, Dialysis services, Geriatric Centre, Physiotherapy Centre, Mental Health Unit, Trauma & Burns Unit, strengthening of facilities for Orthopaedic, Oro-dental, Eye and ENT Departments, Tobacco Cessation Centre, Obesity Guidance Clinic.  Tertiary Care for advanced management of complicated cases including radiotherapy for cancer, cardiac emergencies including cardiac surgery, neurosurgery, organ transplantation.  Emergency medical care and rapid referral system including Highway Trauma Centres and 108 emergency services.  Health Promotion & Prevention includes legislation, population based interventions, Behaviour Change Communication using mass media, mid- media and interpersonal counselling and public awareness programmes in different settings (Schools, Colleges, Work Places and Industries).14.3 ESTIMATED BUDGET DURING 12TH FIVE YEAR PLAN It is envisaged that for comprehensive and sustainable programme toprevent, control, manage important non-communicable diseases and key riskfactors across the country, a large investment would be required during the 12thPlan, Rs. 58,072 crore would be required over the period of 2012-17.14.4 EXPECTED OUTCOMES The programmes and interventions would establish a comprehensivesustainable system for reducing rapid rise of NCDs, disability as well as deaths dueto NCDs. Broadly, following outcomes are expected at the end of the 12th Plan are:a) Early detection and timely treatment leading to increase in cure rate and survival.b) Reduction in exposure to risk factors, life style changes leading to reduction in NCDs.c) Improved mental health and better quality of life.d) Reduction in prevalence of physical disabilities including blindness and deafness.e) Providing user friendly health services to the elderly population of the countryf) Reduction in deaths and disability due to trauma, burns and disasters.g) Reduction in out-of-pocket expenditure on management of NCDs and thereby preventing catastrophic implication on affected individual and families. 14
  15. 15. 15. AYUSH and NCDs The representative of Government of Sikkim, shared their experience ofcontrolling NCDs through AYUSH (Ayurveda, Yoga, Unani, Siddha andHomeopathy) intervention. They also stated that they have identified 72% ofdisease of hypertension in a particular village has been considerably brought downthrough the AYUSH intervention. Govt of India, and Department of AYUSH withstate health secretaries on 25.4.2012 determined that AYUSH professional andfacilities to be geared up for assisting national health programmes under NPCDCS(National Programme for Prevention and Control of Cancer, Diabetes,Cardiovascular disorders). Also, they said Training and IEC (Information EducationCommunication) material on preventive & promotive role of AYUSH system incontrolling NCDs would be prepared by Department of AYUSH for sharing withStates.2516. GLOBALIZATION AND ITS IMPLICATIONS FOR HEALTH CAREAND NURSING PRACTICE Globalization describes the increasing economic and social interdependence between countries. Nursing is challenged with responding to the changing health needs of the global population that have arisen as a result of globalization. 26 The World Health Organization (WHO) Global Forum for Government Chief Nursing and Midwifery Officers (GCNMO) took place on May 16-17th, 2012, while the Triad meeting, Nursing leaders discussed how to strengthen the role of nursing and midwifery in NCDs. Leaders agreed that in order to tackle the issue of NCDs, continuous development is needed in nursing education, research, and nursing leadership in policy. All nursing leaders fully agreed that the issue of NCDs should be mediated by nurses using an upstream approach rather than a downstream approach. In the downstream approach, nurses treat a problem that is already occurred. In the upstream approach, nurses prevent the consequences by using their skills and knowledge to educate the patient and prevent the disease from occurring in the first place.2717.0 CONTRIBUTION TOWARDS PREVENTION AND TREATMENT OF“NCDs” BY NIMHANSNIMHANS is one of the exceptional foundations rendering wide-range care towardsnon communicable diseases through following activities  Preventive, Promotive Rehabilitative health care has been provided through the multidisciplinary team members includes Nurses, Psychiatrist, and Neurologist, Neurosurgeons, Psychologist, Social workers, Yoga therapist, Ayurvedic personnel and supportive workers from all the departments.  Community health unit is providing its continuous extraordinary comprehensive services through the organizational employees and graduate and post graduate students towards NCDs and other diseases in community. 15
  16. 16.  The epidemiology department is giving tremendous support by doing the surveillance among all the NCDs. Several research projects with focus on risk factors (tobacco, alcohol, stress, physical inactivity, unhealthy diet, along with large number of mental health behaviours) have been completed in the department. The findings have resulted in developing intervention programmes and follow-up studies at different levels.  Continuous ongoing research work has been performed by all departments towards NCDs especially, stroke, epilepsy, psychiatric disorders, other neurological and neurosurgical disorders, injuries, genetic disorders and psychosocial problems in all age groups.  Health education and publication departments are delivering incredible, effort towards NCDs through awareness programs.  NIMHANS is one of the major collaborators with Fogarty Indo-US Training Program on Chronic Non-Communicable Diseases (CNCD) Across Lifespan to reduce the training gap and increase research capacity for CNCDs,  NIMHANS contributes its enormous effort on Health Policies and National Health Programs to prevent and control NCDs, especially District and National Mental Health Programs.18. RESEARCH ABSTRACT Decola P et al (2012) highlighted in their stratified representative researchsurvey of 1600 nurses in eight countries were conducted to understand better, hownurses perceive their roles in addressing risk factors associated with NCDs as wellas the types of supports required in order to facilitate this work. The study alsoexplores nurses changing views of the profession and their practice environment.Key findings included that 95% of nurses wanted to use their knowledge, skills andtime to educate individuals on the threat and prevention of NCDs, but workload, timeconstraints and their perception towards the job of nursing hinder them fromachieving their potential.2819. CONCLUSION Within a couple of decades, NCDs are poised to dominate the health careneeds in most low and middle income countries and to exact a significant human andeconomic toll on countries and their population. Despite the magnitude of thechallenges, there is considerable scope for action. Improved health care, earlydetection and timely treatment is another effective approach for reducing the impactof NCDs. Health systems need to be further strengthened to deliver an effective,realistic and affordable package of interventions and services for people with NCDs. 16
  17. 17. 20. REFERENCES 1. World Health Organization, Ministery of family welfare. Draft Background paper. National Summit on non communicable disorder. New Delhi; 2011;1-30 2. Ajay Mahal, Anup Karan, Michael Engelgau. The Economic Implications for Non- communicable Disease for India. The World Bank. Jan 2010. 3. Park.k. Preventive and Social Medicine.19th Edition. Jabalpur: M/S Banarsidas Bhanot publication; 2007. 301-345 4. World Health Organization. Global status report on non-communicable diseases. Geneva: 2010; 10-30,40,56 5. Ministry of Health & Family Welfare, GOI. Report of the National Commission on Macroeconomics and Health. New Delhi: 2005;19-20, 276 6. Joshi R, Cardona M, Iyengar S, Sukumar A, Raju CR, Raju KR, Raju K, Reddy KS, Lopez A, Neal B. Chronic diseases now a leading cause of death in rural India-- mortality data from the Andhra Pradesh Rural Health Initiative. International Journal Epidemiology ; December; 35(6); 2006 ;1522-9 7. Report of the Working Group on Disease Burden for 12th Five-year Plan,No.2(6)2010-Ministry of Health and Family Welfare, Government of India Planning Commission. Yojana Bhavan. New Delhi :Dated 9th May 2011;10-60 8. International Diabetes Federation.IDF Diabetes Atlas.4th Edition. December 2009 9. Mohan V, Mathur P, Deepa R, Deepa M, Shukla DK, Menon GR, Anand K, Desai NG, Joshi PR Mahanta J, Thankappan KR, Shah B. Urban rural differences in prevalence of self-reported diabetes in India. The WHO-ICMR Indian NCD risk factor surveillance. Diabetes research and clinical practice. 2008; 80:159-168 10. World Health Organization. A Prioritized Research Agenda for Prevention and Control of Non-communicable Diseases. 2011; 13, 39 ( / about / licensing / copyright_form/en/index.html). 11. National Institute of Medical Statistics and Indian Council of Medical Research (ICMR), 2009, IDSP Non-Communicable Disease Risk Factors Survey, Phase-I States of India. National Institute of Medical Statistics and Division of Non- Communicable Diseases. Indian Council of Medical Research. New Delhi: India: 2007-08. 12. Ramnath Takiar, Deenu Nadayil, A Nandakumar. Projections of Number of Cancer Cases in India (2010-2020) by Cancer Groups. Asian Pacific Journal of Cancer Prevention. 2010;Vol 11: 1045 13. Ministery of health and family welfare .National commission on macro economics and health background papers. GOI. Burden of disease in India forecasting vascular disease cases and mortality in India: P207. 14. D. Wayne Taylor. The Burden of Non- Communicable Diseases in India. The Cameron Institute. 2010;1-10 15. Ministry of Home Affairs. Report on causes of death in India. Office of the Registrar General of India. New Delhi: 2009; pp 17 16. Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the challenge of chronic diseases in India. Lancet. 2005:366:1744-1749. 17
  18. 18. 17. ICMR study .Indian Study on the Asthma, Respiratory symptoms and Chronic Bronchitis- (INSEARCH- 2006-09). 2010;p20-2818. Vyas J N ,Niraj Ahuja.Text book of post graduate psychiatry. Second Edition. New Delhi;Jaypee brothers; 2003.19. Gururaj et .al Alcohol related harm. Implication for public health and policy in India Nimhans: 2011.20. WHO. Investing in mental health. / entity / mental.../ Zambia% 20 Country%20 report.pdf:2003; Page.No. 08-1021. WHO country office for India. Mental and Behavioural disorders (2011); Page No 1-222. Richard Smith, Paul, Corrigan & Christopher Exeter. Countering non-communicable disease through innovation. Report of the Non-Communicable Disease Working Group. The global health policy summit. 2012;p1-2023. Olusoji Adeyi, Owen Smith, Sylvia Robles. Public Policy and the Challenge of Chronic Non-communicable Diseases. The world bank .Washington.D.C:2007p;1- 27,10324. World Health Organization. 2008-2013 action plans for the global strategy for the prevention and control of non-communicable diseases. Prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. 2008:1-3425. Department of AYUS, GOI. Minutes of meeting. New Delhi: 17 th may; 201226. Bradbury-Jones C. Globalization and its implications for health care and nursing practice. Nurs Stand. 2009; Feb 25-Mar 3; 23 (25): 43 – 7. [Pub Med-indexed for MEDLINE)27. http:// nursing. duke. Edu / news / nurses-world-address-non communicable- diseases student%E2%80%99s-viewpoint, May 25; 201228. Decola P., Benton D., Peterson C., & Matebeni D. Nurses potential to lead in non- communicable disease global crisis. International Nursing Review;2012 18