2. Outline Global perspective Framework for NCDs surveillance Example of Epidemiology of NCDs in Thailand Priority of interventions and actions for NCDs
7. Increasing burden of NCDs Two of three deaths each year are attributable to NCDs. Four-fifths of these deaths are in low-income and middle-income countries, and a third are in people younger than 60 years. Overall, age-specific NCD death rates are nearly two-times higher in low-income and middle-income countries than in high-income countries. NCDs often cause slow and painful deaths after prolonged periods of disability. In all regions of the world, total numbers of NCD deaths are rising because of population ageing and the globalisation of risks, particularly tobacco use. In addition to the longstanding challenges of curtailing infectious disease, this double burden of disease places enormous strains on resource-deficient health systems. Alwan A. et al. Lancet. 2010;376:1861-8.
8. Mortality in these 23 countries: 23.4 million (80% of all deaths from NCDs) in low middle incomes. Alwan A. et al. Lancet. 2010;376:1861-8.
9. 41 % deaths from -Stroke, IHD, DM, HT, COPD, Cervical Liver Cancer 34.3% deaths from Stroke, IHD, DM, COPD, Lung and Liver Cancer Porapakkhamet al. Population Health Metrics 2010, 8:14
10.
11. Associations between poverty, NCDs and development goals MDG: Millennium development goal Beaglehole R etal. Lancet online April 6, 2011
15. Surveillance On going systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of pubic health practice closely integrated with the timely dissemination of these data to those who need to know.
17. Framework for national NCD surveillance system, WHO Exposure (Risk factors) Behavioral and dietary/nutritional risk factors Physiological and metabolic risk factors Outcomes Mortality Morbidity Health system response Interventions Health system capacity
18. Core NCDs surveillance indicators Tobacco use Alcohol consumption Physical activity Diet: fruit and veg consumption Anthropometric Low birth weight Prevalence of BMI status Prevalence of raised BP, not aware, not Rx Prevalence of IFG, diabetes Blood total blood cholesterol Mortality indicators All cause, cause-specific Morbidity Cancer incidence Diabetes Health system HS capcity, # trained human resources for NCD % of pop access to essential medicine Economic expenditure for NCD
27. Some technical issues Validity, coverage, timeliness Numerator: prevalence and incidence Definition How to find the cases Denominator Hospital data Surveillance Interview data Questionnaire
30. Interview data High non-response rate. Respondent may be have disease but mayhave no symptom, or not aware of the disease. Respondent may not recall related to the illness. Interviewer may ask the question incorrectly Information bias.
31. Some limitation of hospital data Selective in relation to Personal characteristic Severity of disease Associated condition Admission policy Maybe Incomplete, missing Variable in diagnostic quality Population at risk (denominator) is not defined
32. Mortality trends issue: Artifactual: Numerator Errors in diagnosis Errors in age Changes in coding rules, classification Denominator Errors in counting population Errors in classification by demographic( age, race, sex) Real: Change in survivorship Changes in incidence Change in age composition od population Combined of the above factors
36. Primary prevention Population approach Whole population, aim to reduce risk Shift the whole population risk eg. Increase cigarette tax High risk approach Focus on individuals Require screening program to identify high risk
46. 5-cost effective intervention Tobacco control Salt reduction Healthy diet and physical activity Reduce harmful drink of alcohol Essential drugs for CVD
