prevention and control of Non Communicable Disease

1. Prevention and control of
Non Communicable Disease
Vipin K Ravi

2. CONTENTS
Introduction
Gaps in natural history
GLOBAL initiative
 GLOBAL ACTION PLAN
 BEST BUY initiatives
National frame work

3. Introduction

5. Prevention
• Activities to people from getting the disease.
Or stop a disease from getting worse.
• E.g health promotion activities
• early detection programes

6. Prevention and control
Control
Activities to slow the course of an existing
disease or reduce its severity
• Activities to control a disease occur after the
disease has been contracted.
• Control activities slow down the pathological
effect from the disease.

7. GAPS in Natural History
• Absence Of A Known Agent
• Multifactorial Causation
• Long Latent Period
• Indefinite Onset

8. GLOBAL AND NATIONAL INITIATIVES
• STEPS survey 2003
• WHO Report on NCD – 2008
• Who global non communicable network-2009
• NCD ALLIANCE-2009
• UN Assembly session 2010
• First High level committee meet-2011
• UNIATF -2013

9. GLOBAL AND NATIONAL INITIATIVES
• Global action plan 2013-2025
• Second High level committee meet -2014
• Global status report on NCD 2014
• WHO High level commission on NCD-2017
• SDG 2030 –
• FCTC -2003
• NPCDCS- 2010

10. GLOBAL ACTION
PLANFOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE
DISEASES
2013-2020

11. Global Action plan
• Global action plan for the prevention and
control of NCDS(2013 to 2020)
Vision
A world free of the avoidable burden of non
communicable diseases.
6 objectives ,9 NCD global targets, 25 indicators

12. (GAPS -2013-2020)
Goal
• To reduce the preventable and avoidable
burden and disability due to non
communicable disease by means of
multisectoral collaborarion and corporation at
national ,regional and global level so that
population reach the highest attainable
standards of health and productivity at every
age and those diseases no longer a barrier to
wellbeing or socioeconomic development.

13. GAP 2020-OBJECTIVES
1.To Raise The Priority Accorded To The
Prevention And Control Of Non communicable
Diseases In Global, Regional And National
Agendas And Internationally Agreed
Development Goals, Through Strengthened
International Cooperation And Advocacy.

14. GAP 2020-OBJECTIVES
2. To strengthen national capacity, leadership
,governance multisectoral action and
partnership to accelerate country response for
prevention and control of NCD

15. GAP 2020-OBJECTIVES
3.To reduce modifiable risk factors for NCD and
underlying social environment through
creation of health promoting environment

16. GAP 2020-OBJECTIVES
4.To strengthen and orient health system to
adddress the prevention and control of NCD
and underlying social determinants through
people centered primary health care and
universal health coverage.

17. GAP 2020-OBJECTIVES
5.To promote and support national capacity for
high quality research and development for
prevention and control of NCD .

18. GAP 2020-OBJECTIVES
6.To Monitor The Trends And
Determinants Of Noncommunicable
Diseases And Evaluate Progress
In Their Prevention And Control.

19. Targets of GAP-2020

20. Targets of GAP 2020
• 1. A 25% relative reduction in the overall
mortality from cardiovascular diseases,
cancer, diabetes, or chronic respiratory
disease

21. Targets of GAP 2020
2.A 10 per cent relative reduction in harmful
use of alcohol as appropriate within national
context

22. Targets of GAP 2020
3.10 per cent relative reduction in prevalence of
insufficient physical activity.
4.10 per cent relative reduction in mean salt
intake/ sodium
5.A 30 per cent reduction in prevalence of
current tobacco use in person aged 15+ years

23. Targets of GAP 2020
6.A 25 per cet relative reduction in pravalence
of raised blood pressure.
7.Halt the rise of diabetes and obesity

24. Targets of GAP 2020
8. At least 50 per cent of eligible people receive
drug therapy and counseling (including
glycemic control) to prevent heart attack and
stroke.

25. Targets of GAP 2020
• 9. 80 per cent availability of affordable
technology and essential medicines including
generics required to treat major NCD in public
and private facilities

26. UNIATF
The United Nations Interagency Task Force (UNIATF)
on the Prevention and Control of NCDs coordinates
the activities of relevant UN organizations and other
inter-governmental organizations to support
governments to meet high-level commitments to
respond to NCD epidemics worldwide.

27. FCTC
• The WHO FCTC was developed in response to
the globalization of the tobacco epidemic
• The Convention represents a milestone for the
promotion of public health and provides new
legal dimensions for international health
cooperation.
• INDIA Launced National tobacco control
program 2007

28. “Best Buys”
From Burden to “Best Buys”:
• Reducing the Economic Impact of Non-
Communicable Diseases in Low- and Middle-Income
Countries
• Individual-based NCD “best buy” interventions
• – which range from counselling and drug therapy for
cardiovascular disease to measures to prevent
cervical cancer
• Population based and indivdual based

29. Pigovian tax
• Pigovian tax is a tax on any market activity that
generates negative externalities (costs not
included in the market price).
• The tax is intended to correct an inefficient
market outcome, equal to the social cost of the
negative externalities.
• examples of externalities are environmental
pollution, and increased public healthcare costs
associated with tobacco and sugary drink
consumption.

31. Best Buys Intervention

32. SDG on NCD
• SDG includedspecific target for NCDS
• Target 3.4 one third reduction in premature
mortality from NCDs by the year 2030 through
prevention and treatment and promote mental
health and wellbeing
• 3.5 strengthen and treatment of substance
abuse,including narcotic drugs and harmful use of
alcohol

33. SDG on NCD
• Target 3.6 half the deaths due to injuries and
accidents
• Target 3.a strengthen the implementation of WHO –
Framework convention on tobacco control by all
countries

34. NPCDCS
Durinf 11th plan ,100 districts in 21 states.
National Programm on prevention and control of
candiabetes,cardiovascular disease and stroke was
started,
NPCDC+NCCP = NPCDCS
12 th 5 yr plan covered all the districts

35. Objectives –npcdcs
1. Prevent and control common NCDs through
behavior and lifestyle changes.
2.Provide early diagnosis and treatment of common
NCD.
3.build capacity building at various levels of health
care for prevention ,diagnosis and treatment of
common NCD

36. Objectives –NPCDCS
4.Train HR within public health set up, doctors, nurses
Para medical staff to cope with the increasing burden
of NCD
5.Establish and develop capacity for palliative and
rehabilitative care

37. NPCDCS- Subcenter Level
Health promotion for behavioral and life skill changes
Oppertunistic screening of population above 30 years
by using BP measurement and blucose by strip
method;
Test strip and lacent are being procured at central
level
Suspected cases will be refered to CHC

38. Activities at CHC
NCD CLINICS- diagnosis by required investigations
Like blood sugar, lipid profile, ultra sound,X ray and
ECG, management of Common NCDs
Duties of the nurses under the program
 undertake home visits for bedridden patients
 Supervise the work of health workers
 Monthly clinic in the village in random basis
Complicated cases shall be referred to district hospital

39. Activities at DISTRICT Level
NCD CLINICS at District level-screen persons above 30
for DM,HT and CVD
To Identify Individuals are at high risk of developing
NCDs and warranting further investigation / action
Detailed investigation ON individuals at high risk of
developing NCD and those who are referred from
CHCs

40. Activities at DISTRICT Level
Regular management and annual assessment
Home based care- palliative care
Promotion of healthy life style

41. Urban health schemes for diabetes
and hypertension
1. To screen urban slum population for DM and
BP.
2. To create data base for the prevalence of
DM and HT in urban slums
3. Sensitize urban slum population about
healthy life style

42. New initiatives
• 1.intervention for prevention and control of
RHD under NPCDCS and RBSK
• Integration of AYUSH doctors with NPCDCS
• Integration of RNTCP with NPCDCS

43. OPERATIONAL GUIDELINES
• 1, Systolic BP >140mm of hg, diastolic BP
>90mmof hg,RBS >140 (REFER To MO)
• SUSPECTED CANCER/Precancer CASES will be
refered to screeing sites to the appropriate
PHC/CHC/DH
• Once diagnosed the patients must receive one
month of treatment from the phc
• Once stable provide medicines for 3months

44. OPERATIONAL GUIDELINES
• ANM/ASHA visiting the patient each month.
• 3MONTH drug supply could be stocked with
the ANM at the subcenter,to be given each
month
• The patient will need to go to the PHCs for
first follow up at the end of 3 months. Annual
specialized consultation at the nearest nodal
Chc/DH

45. OPERATIONAL GUIDELINES
• 5.Those who are already under treatment of a
private practitoner could be offered medicines
from public health
• 6.community follow up by ASHA

46. Tobacco Control Legislation
The Cigarettes and Other Tobacco Products
(Prohibition of Advertisement and Regulation of
Trade and Commerce, Production, Supply and
Distribution) Act, 2003 or COTPA, 2003
This Act was enacted by the Parliament to give effect
to the Resolution passed by the 39th World Health
Assembly.

47. REFERENCES
• K Park 23 rd edition p 501-550,432
• Who (2013) global action plan for the
prevention and control of NCD.

48. THANK YOU

52. • Prevention and control
1.CVD
2.DM
3.CANCER
4.COPD
5.ACCIDENTS AND INJURIES
6.HYPERTENSION
7.STRESS
8.RHD

53. 1.Unconditional probability of dying between ages
of 30 and 70 from cardiovascular diseases, cancer,
diabetes or chronic respiratory diseases.
2 Cancer incidence, by type of cancer, per 100 000
population

54. INTRODUCTION
• Noncommunicable diseases (NCDs)—mainly
cardiovascular diseases, cancers, chronic respiratory
diseases and diabetes—are the world’s biggest killers.
More than 36 million people die annually from NCDs
(63% of global deaths), including more than 14 million
people who die too young between the ages of 30 and
70. Low- and middle-income countries already bear
86% of the burden of these premature deaths, resulting
in cumulative economic losses of US$7 trillion over the
next 15 years and millions of people trapped in poverty.

55. • Most of these premature deaths from NCDs are
largely preventable by enabling health systems to
respond more effectively and equitably to the
health-care needs of people with NCDs, and
influencing public poli- cies in sectors outside
health that tackle shared risk factors—namely
tobacco use, unhealthy diet, physical inactivity,
and the harmful use of alcohol.

56. • NCDs are now well-studied and understood, and
this gives all Member States an immediate
advantage to take action. The Moscow
Declaration on NCDs, endorsed by Ministers of
Health in May 2011, and the UN Political
Declaration on NCDs, endorsed by Heads of
State and Government in September 2011,
recognized the vast body of knowledge and
experience regarding the preventability of NCDs
and immense opportuni- ties for global action
to control them

57. • . Therefore, Heads of State and Government
committed themselves in the UN Political
Declaration on NCDs to establish and
strengthen, by 2013, multisectoral national
policies and plans for the prevention and
control of NCDs, and consider the
development of national targets and
indicators based on national situations.

58. • To realize these commitments, the World
Health Assembly endorsed the WHO Global
Action Plan for the Prevention and Control of
NCDs 2013-2020 in May 2013. The Global
Action Plan provides Member States,
international partners and WHO

59. • with a road map and menu of policy options
which, when implemented collectively
between 2013 and 2020, will contribute to
progress on 9 global NCD targets to be
attained in 2025, including a 25% relative
reduction in premature mortality from NCDs
by 2025. Appendix 3 of the Global Action
Plan is a gold mine of current scientific
knowledge and available evidence based on a
review of international experience.

60. • WHO’s global monitoring framework on
NCDs will start tracking implementation of
the Global Action Plan through monitoring
and reporting on the attainment of the 9
global targets for NCDs, by 2015, against a
baseline in 2010.

61. • Accordingly, governments are urged to
• (i) set national NCD targets for 2025 based
on national circumstances;
• (ii) develop multisectoral national NCD plans
to reduce exposure to risk factors and enable
health systems to respond in order to reach
these national targets in 2025; and
• (iii) measure results, taking into account the
Global Action Plan.

62. • Taking note with appreciation of all the region- al initiatives undertaken on the
prevention and control of noncommunicable diseases, in- cluding the Declaration
of the Heads of State and Government of the Caribbean Commu- nity entitled
“Uniting to stop the epidemic of chronic noncommunicable diseases”, adopted in
September 2007, the Libreville Declaration on Health and Environment in Africa,
adopted in August 2008, the statement of the Com- monwealth Heads of
Government on action to combat noncommunicable diseases, adopted in
November 2009, the declaration of com- mitment of the Fifth Summit of the
Americas, adopted in June 2009, the Parma Declaration on Environment and
Health, adopted by the Member States of the WHO European Region in March
2010, the Dubai Declaration on Diabetes and Chronic Noncommunicable Diseases
in the Middle East and Northern Africa Region, adopt- ed in December 2010, the
European Charter on Counteracting Obesity, adopted in November 2006, the
Aruba Call for Action on Obesity of June 2011, and the Honiara Communiqué on
ad- dressing noncommunicable disease challenges in the Pacific region, adopted
in July 2011;

63. • endorsed by the Sixty-fourth World Health As-
sembly (resolution WHA64.11), which requests
the Director-General to develop, together with
relevant United Nations agencies and entities,
an implementation and follow up plan for the
outcomes of the Conference and the High-level
Meeting of the United Nations General Assem-
bly on the Prevention and Control of Non-com-
municable Diseases (New York, 19–20 Sep-
tember 2011) for submission to the Sixty-sixth
World Health Assembly;

64. • Acknowledging also the Rio Political Declaration
on Social Determinants of Health adopted by
the World Conference on Social Determinants of
Health (Rio de Janeiro, 19–21 October 2011), en-
dorsed by the Sixty-fifth World Health Assembly
in resolution WHA65.8, which recognizes that
health equity is a shared responsibility and re-
quires the engagement of all sectors of govern-
ment, all segments of society, and all members
of the international community, in an “all for
equity” and “health-for-all” global action

65. Target Indicator
MORTALITY & MORBIDITY
A 25% relativeUnconditional probability of dying
between ages of 30 and 70 from cardiovascular
diseases, cancer, diabetes or chronic respiratory
diseasesreduction in the overallPremature mortality
from noncommunicable diseasemortality
fromcardiovascular diseases, cancer, diabetes,
orchronic respiratory diseases
Additional indicator
Cancer incidence, by type of cancer, per 100 000
population

66. • A global analysis of the economic impact of
NCDs by the World Economic Forum and the
Harvard School of Public Health
• An analysis of the costs of scaling up a core
intervention package in low- and middle-
income countries by the World Health
Organization

79. INDICATORS
1.Unconditional probability of dying between ages
of 30 and 70 from cardiovascular diseases, cancer,
diabetes or chronic respiratory diseases.
2 Cancer incidence, by type of cancer, per 100 000
population

80. 3.Total (recorded and unrecorded) alcohol per capita (aged
15+ years old) consumption within a calendar year in
litres of pure alcohol, as appropriate, within the national
context
4.Age-standardized prevalence of heavy episodic drinking
among adolescents and adults, as appropriate, within
the national context
5.Alcohol-related morbidity and mortality among
adolescents and adults, as appropriate, within the
national context

81. 6.Prevalence of insufficiently physically active
adolescents, defined as less than 60 minutes of
moderate to vigorous intensity activity daily
7.Age-standardized prevalence of insufficiently
physically active persons aged 18+ years (defined
as less than 150 minutes of moderate-intensity
activity per week, or equivalent)

82. 8.Age-standardized mean population intake of salt
(sodium chloride) per day in grams in persons aged
18+ years
9.Prevalence of current tobacco use among
adolescents
10.Age-standardized prevalence of current tobacco
use among persons aged 18+ years