New Frontiers in NCDs_Sangiwa_5.1.12


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  • Chronic Diseases (source: WHO and NCD alliance) Not ideal but currently we have no better terminology as such the consensus is to keep what has been used in the last four decades, In fact WHO and UN are going to retain NCD as terminology for now as they believe it is even more challenging to characterize what constitute Chronic diseases.
  • 8 million preventable NCD deaths from among children, adolescents and working age adults alone. That’s more than the 6 million AID, TB, malaria
  • This is an example of the disparities that the world is witnessing today: 56 percent of people who die from NCDs in Sierra Leone die before the age of 60 years, while in Sweden only 7 percent die before the age of 60. Now, dying before the age of 60 is not only important in relation to health, but it’s also important in relation to productivity and in relation to socioeconomic development
  • Targets and Indicators taken from: This is WHO”s set of recommended voluntary global targets for the prevention and control of NCDs
  • 07/05/12
  • New Frontiers in NCDs_Sangiwa_5.1.12

    1. 1. Stronger health systems. Greater health impact. The Decade of Chronic Non-Communicable Diseases (C-NCDs)D r. G loria S angiwaD ire ctor of Te ch nical Q u ality and InnovationM anage m e nt S cie nce s for H e althC O Management SciencesS pHealth M e e ting, M ay 1 , 201 2 R E G rou p for ring 1
    2. 2. Outline• What are Chronic Non-Communicable Diseases (Chronic NCDs)?• Why is there an increased global focus on the need to tackle Chronic NCDs in low and middle-income countries (LMICs)?• What have been the global responses?• What is needed to address Chronic NCDs in LMICs? Management Sciences for Health 2
    3. 3. Chronic Non-Communicable Diseases Definedhronic Non-Communicable Diseases abbreviated as ChronicNCDs: • Defined as diseases or conditions that occur in, or are known to affect, individuals over an extensive period of time and for which there are no known causative agents that are transmitted from one affected individual to another.owever: » Chronic conditions are not limited to non-communicable diseases. Public health specialists increasingly view HIV/AIDS as a chronic condition. » Some cancers are attributed to infectious agents (e.g. HPV and Cervical Cancer or Hepatitis and Liver Cancer). Management Sciences for Health 3
    4. 4. What are the main Chronic NCDs and why are they grouped together?Management Sciences for Health 4
    5. 5. Big Four (+) and Causal LinksBig Four + : Cardiovascular Disease; Diabetes; Cancers; ChronicRespiratory Diseases Causal links ris iolog olic NCDs ac ical ys tab s tor Raised blood pressure ph /Me Overweight/obesity kf Raised blood glucose Raised lipids ac al k f ur s tor ris avio Tobacco use Unhealthy diet h Be Physical inactivity Harmful use of alcohol ers riv Social gd Globalization yin Determinants Urbanization erl of Health Population ageing d Un [Source: WHO, Dr. Ala Alwan] Management Sciences for Health 5
    6. 6. Why we are seeing an increased global focus on addressing Chronic NCDs in LMICs?Management Sciences for Health 6
    7. 7. Chronic Non-Communicable Diseases(NCDs): A Global ChallengeThere is a high and increasing global burden of chronic NCDs  Chronic NCDs account for 60% (35 million) of global deaths annually  80% (28 million) of these deaths occur in low- and middle- income countries  8 million preventable chronic NCD deaths occur among those < 60 years ­ Comparison: AIDS, TB, and Malaria account for 6 million Source: WHO Management Sciences for Health 7
    8. 8. Age-standardized death rates for ChronicNCDs are higher in low & middle incomecountries Total chronic NCD death rates, age standardized, Males, 2008 Source: WHO Global Health Observatory, 2011 Management Sciences for Health 8
    9. 9. Chronic NCDs are killing people at a younger age in low & middle income countriesPercentage of all chronic NCD deaths occurring under age of 70, Males, 2008 Source: WHO Global Health Observatory, 2011 Sciences for Health 9
    10. 10. Chronic NCD major risk factors – vary among countries, often increasing with economic growth Darker colors = increased risk (see source for specific risk levels) Cigarette consumption Overweight Inadequate Alcohol consumption physical activity Source: WHO Global Health Observatory, 2011 Sciences for Health 10
    11. 11. Those in Developing Countries…  Tend to develop Chronic NCDs a decade earlier in life  Have more preventable complications  Are diagnosed at later stages (if at all)  Die sooner than those in high-income countries  Mortality from chronic NCDs before the age of 60 is 3x higher in poorer countries than in rich countriesManagement Sciences for Health 11
    12. 12. Given current trends the problem will getworse before it gets better Projected global deaths (millions of deaths)  33%  58%  89% High Income Middle Income Low Income Source: WHO, Global Burden of Disease, 2004, Figure 15Management Sciences for Health 12
    13. 13. Projected increase of the Chronic NCD burden - low income countriesNumber of Deaths for low income countries (each silhouette = 1 million annual deaths) 2004 2030 (projected)Chronic NCDsHIV, TB, malaria, othersMaternal, perinatal,relatedAccidents/ injuries Chart based on WHO Global Burden of Disease, 2004, figure 15 Management Sciences for Health 13
    14. 14. Global Responses: UN High-level Meeting  “… the global burden and threat of non-communicable diseases constitutes one of the major health challenges…”  “… which undermines social and economic development throughout the world…”  No major new funding for chronic NCDs  Focused on the problems without agreed solutions  Mobilized civil society movement, but public not yet fully engaged  Few champion countriesManagement Sciences for Health 14
    15. 15. Setting Global Targets for Chronic NCDsWHO recommends global targets for the following areas:Mortality from chronic NCDs ObesityDiabetes Prevention of heart attack and strokeTobacco Smoke Cervical cancer screeningAlcohol Elimination of industriallyDietary salt intake produced trans-fats from foodBlood pressure/hypertension supply Management Sciences for Health 15
    16. 16. WHO’s Recommended Targets Target Area Target GoalMortality from NCDs 25% relative reduction in overall mortality from cardiovascular disease, cancer, diabetes, or chronic respiratory diseaseDiabates 10% relative reduction in prevalence of diabetesTobacco smoking 40% relative reduction in prevalence of current tobacco smokingAlcohol 10% relative reduction in persons aged 15+ alcohol per capita consumption (APC)Dietary Salt intake Mean population intake of salt less than 5 grams per dayBlood pressure, 25% relative reduction in prevalence of raised blood pressureHypertensionObesity No increase in obesity prevalencePrevention of heart 80% coverage of multidrug therapy (including glycaemic control) for peopleattack and stroke aged 30+ years with a 10 year risk of heart attack or stroke ≥ 30%, or existing cardiovascular diseaseCervical Cancer 80% of women between ages 30‐49 screened for cervical cancer at leastScreening onceTrans-Fat Elimination of industrially produced trans‐fats (PHVO) from the food supply Management Sciences for Health Source: WHO, 2012 16
    17. 17. Responding to the Chronic NCD Epidemic –what is needed  Whole of society response – public, private, civil society  Universal health coverage (UHC) for financing base  Integration and localization from the beginning  High leverage prevention  Efficiency and cost-consciousness at every step Management Sciences for Health 17
    18. 18. Now is the time for UHC – the example of the “African tigers” with two decades of growth Average Growth Rates per Capita, 1996–2008 Emerging countries Threshold countries Other countries Oil exporters Source: Emerging Africa, Steven Radelet, 2010Management Sciences for Health 18
    19. 19. The Universal Health Coverage movement – Growing “buzz” around the globe Implementing UHC reforms Stated interest in achieving UHCManagement Sciences for Health 19
    20. 20. The Universal Health Coverage (UHC) VisionWorld UHC Coverage: World Coverage:4 out of 10 people are covered 8 out of 10 people are coveredOut-of-Pocket Expenditure: 60% Out-of-Pocket Expenditure: 30% Source: The Rockefeller Foundation; WHA Resolution 58.33 Geneva: WHO 2005 Management Sciences for Health 20
    21. 21. Integration and localization –an example of leveraging existing platformsCervical and Breast Cancer Screening in Eastern Uganda (STAR-E)• Integration of HIV/AIDS and cervical/breast cancer prevention and treatment services• 484 women and girls living with HIV/AIDS screened for cervical and breast cancer in 18 health centers as part of HIV-related care• 884 personal health assistants (PHAs) sensitized on family planning and elimination of maternal-to-child transmission• Patient referrals for cryotherapy for cervical cancer at regional hospitals Management Sciences for Health 21
    22. 22. Efficiency and cost-consciousness - targeting “bestbuy” interventions for prevention and treatment Interventions Cost per person per year (US $) China India Russia1. Tobacco use – Accelerated implementation of the WHO 0.14 0.16 0.49Framework Convention on Tobacco Control2. Dietary salt – Mass‐media campaigns and voluntary action by 0.05 0.06 0.16food industry to reduce consumption3. Obesity, unhealthy diet, and physical inactivity – media 0.43 0.35 1.18campaigns, food taxes, subsidies, labeling, marketing restrictions4. Harmful alcohol intake – Tax increases, advertising bans, and 0.07 0.05 0.52restricted access5. Cardiovascular risk reduction – Combination of drugs for 1.02 0.90 1.73individuals at high risk of NCDsTotal cost per person 1.72 1.52 4.08 Source: Beaglehole et al, Lancet 2011. Management Sciences for Health 22
    23. 23. Take Away Messages• The world faces a growing burden of chronic NCDs.• Chronic NCDs pose a significant burden to the health system and economic development.• Strategies exist to prevent and treat cancer, heart disease, diabetes and lung disease and cost just $1.20 per person per year in LMICs.• The “business as usual” approach is not appropriate.• Health systems strengthening and pharmaceutical management have been identified as one of the critical elements required to meet the long-term needs of people living with chronic NCDs.• Chronic NCDs can be effectively addressed by leveraging existing platforms and investments. Management Sciences for Health 23
    24. 24. Inspiring Quotes……..“Non-communicable diseases(NCDs) represent an epidemic of gigantic proportions and the call to address them nationally, regionally, globally and to dispel the myths that enshroud them has an urgency that is impatient of further debate.”  Sir George Alleyne, UN Special Envoy for HIV in the Caribbean and Former Chair of the Caribbean Commission on Health and Development “The global health community is at a critical crossroads. For the past decade, it was essential to fund interventions for specific diseases because the number of infections was so vast. As demographics change and people are living longer, however, a health systems approach to NCDs has the greatest health impact and ensures that interventions are sustainable, efficient, and effective.”  Jonathan D. Quick, MD, MPH, President and CEO, Management Sciences for Health“As the world grapples with the combined challenges of economic slowdown; the increasing globalization of the economic system and of diseases; and growing demands for chronic care, the need for universal health coverage (and a strategy for financing it) has never been greater.”  Dr. Margaret Chan, Director General, World Health Organization Management Sciences for Health 24
    25. 25. Stronger health systems. Greater health impact. Saving lives and improving the health of the world’s poorest and most vulnerable people by closing the gap between knowledge and action in public health.Management Sciences for Health 25