141st APHA Annual Meeting
Monday, November 4th, 2013

Title Page
Taking Public Health Action to
Stop CNCD
Dr. Elvira Berac...
Disclosure
• Dr. Elvira Beracochea has nothing to
disclose regarding chronic non
communicable diseases.
NCD Facts
Up to 80% of the NCD mortality, mainly due to cancer,
diabetes, chronic lung disease and cardiovascular
disease,...
Objectives
1. Discuss ways to take action to stop
CNCD globally
2. Discuss ways to take action and
stop CNCD locally
3. Ch...
Why Stop CNCDs?
Globally CNCDs are …

Preventable
Reversible
Curable
Etiology

Yet
Poorly
Understood….
Behavioral Risk Factors
1.
2.
3.
4.
5.

Smoking
Alcoholism
Poor nutrition
Physical inactivity
Mental illness and/or stress
The Unfinished Agenda
• Rheumatic Fever
• Barker hypothesis that propose that
exposure to poor nutrition in utero
increase...
North Karelia: Interventions
•PHC providers involved in all aspects of the
program
•Involvement of community organizations...
CARMEN
Conjunto de Acciones para la
Reducción Multifactorial de
Enfermedades No transmisibles
Concerted actions to reduce
...
A New Vertical Program?
Yes, disease control programs are
vertical
Delivery of services, on the other hand
is horizontal a...
How to Stop CNCD Locally
1. Conduct a Community Epidemiological Assessment
2. Every Health Center Must have Program Based ...
How to Stop CNCD Locally
5. Develop/Adapt Patient Monitoring Tools And
Epidemiological Surveillance Standard Procedures
6....
Fagerstrom Test for
Nicotine Dependence
• Apply the test in every community
diagnosis
• Integrate the test in every health...
Fagerstrom Test for
Nicotine Dependence
Is smoking “just a habit” or are you addicted? Take this test and find
out your le...
Fagerstrom Test for
Nicotine Dependence
4. How many cigarettes per day do you smoke?
¨ 10 or less (0)
¨ 11-20 (1)
¨ 21-30 ...
Challenges
• Lack of trained workforce
• Lack of effective essential medicines supply
chains
• Lack of effective surveilla...
Advocacy
•
•
•
•

New MDG: post-2015 agenda
“Program Dose” matters
Sustained efforts also matter
Integrated community base...
References
• Hunter D, Reddy K. Non-communicable
diseases. The New England Journal of
Medicine. October 2013
• Heatherton ...
THANK YOU
1. Tweet one thing you learned today
2. Link with me
3. Email me how you will make an
impact on CNCDs in 2014
Dr...
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Taking Public Health Action To Stop Chronic NonCommunicable Diseases

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A look as ways to take action to stop the spread of CNCDs locally and globally.

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Taking Public Health Action To Stop Chronic NonCommunicable Diseases

  1. 1. 141st APHA Annual Meeting Monday, November 4th, 2013 Title Page Taking Public Health Action to Stop CNCD Dr. Elvira Beracochea MIDEGO, Inc. President info@midego.com
  2. 2. Disclosure • Dr. Elvira Beracochea has nothing to disclose regarding chronic non communicable diseases.
  3. 3. NCD Facts Up to 80% of the NCD mortality, mainly due to cancer, diabetes, chronic lung disease and cardiovascular disease, can be prevented by improved individual care and public health programs. 80% of deaths occur in developing countries CNCDs will account for 70% of global deaths by 2030 10 billion people will die of tobacco related conditions in the next 10 years
  4. 4. Objectives 1. Discuss ways to take action to stop CNCD globally 2. Discuss ways to take action and stop CNCD locally 3. Choose one action to take in 2014
  5. 5. Why Stop CNCDs?
  6. 6. Globally CNCDs are … Preventable Reversible Curable
  7. 7. Etiology Yet Poorly Understood….
  8. 8. Behavioral Risk Factors 1. 2. 3. 4. 5. Smoking Alcoholism Poor nutrition Physical inactivity Mental illness and/or stress
  9. 9. The Unfinished Agenda • Rheumatic Fever • Barker hypothesis that propose that exposure to poor nutrition in utero increases CNCD
  10. 10. North Karelia: Interventions •PHC providers involved in all aspects of the program •Involvement of community organizations and residents •Training of health workforce •Media Communication: Health Literacy •Environmental changes •Partnerships with food industry
  11. 11. CARMEN Conjunto de Acciones para la Reducción Multifactorial de Enfermedades No transmisibles Concerted actions to reduce multifactorial non- transmissible or non-communicable diseases
  12. 12. A New Vertical Program? Yes, disease control programs are vertical Delivery of services, on the other hand is horizontal and must be integrated and focused on addressing the unique epidemiological profile of each community and every individual’s diagnosis
  13. 13. How to Stop CNCD Locally 1. Conduct a Community Epidemiological Assessment 2. Every Health Center Must have Program Based On Assessment Results 3. Train Professionals on Screening, Counseling and Treatment and Assign A Number Of Households And A Denominator to be Accountable for 4. Plan and Implement Community Programs: 1. Tobacco Dependence 2. Nutrition And Physical Activity 3. Screening, Medical Treatment And Self-care Education
  14. 14. How to Stop CNCD Locally 5. Develop/Adapt Patient Monitoring Tools And Epidemiological Surveillance Standard Procedures 6. Conduct Staff Meetings for Weekly , Monthly And Annual Program Reviews 7. Prepare and Deliver Regular Reports To The Community Structures, Local authorities and Sustain Community Involvement
  15. 15. Fagerstrom Test for Nicotine Dependence • Apply the test in every community diagnosis • Integrate the test in every healthcare delivery encounter with a smoker • Explain what nicotine addiction is and how it works • Provide tobacco dependence treatment
  16. 16. Fagerstrom Test for Nicotine Dependence Is smoking “just a habit” or are you addicted? Take this test and find out your level of dependence on nicotine. 1. How soon after you wake up do you smoke your first cigarette? ¨ After 60 minutes (0) ¨ 31-60 minutes (1) ¨ 6-30 minutes (2) ¨ Within 5 minutes (3) 2. Do you find it difficult to refrain from smoking in places where it is forbidden? ¨ No (0) ¨ Yes (1) 3. Which cigarette would you hate most to give up? ¨ The first in the morning (1) ¨ Any other (0)
  17. 17. Fagerstrom Test for Nicotine Dependence 4. How many cigarettes per day do you smoke? ¨ 10 or less (0) ¨ 11-20 (1) ¨ 21-30 (2) ¨ 31 or more (3) 5. Do you smoke more frequently during the first hours after awakening than during the rest of the day? ¨ No (0) ¨ Yes (1) 6. Do you smoke even if you are so ill that you are in bed most of the day? ¨ No (0) ¨ Yes (1) 0-2 Very low dependence 6-7 High dependence 3-4 Low dependence 8-10 Very high dependence 5 Medium dependence
  18. 18. Challenges • Lack of trained workforce • Lack of effective essential medicines supply chains • Lack of effective surveillance systems • Lack of health centers with diagnostic facilities • Lack of chronic delivery models (ANC/PNC still not effective) • Lack of political will • Lack of country leadershiop
  19. 19. Advocacy • • • • New MDG: post-2015 agenda “Program Dose” matters Sustained efforts also matter Integrated community based programs and health centers with trained staff do work: – Services tailored to the community needs – Community involvement and participation
  20. 20. References • Hunter D, Reddy K. Non-communicable diseases. The New England Journal of Medicine. October 2013 • Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addictions 1991;86:1119-27 • North Karelia • PAHO - CARMEN
  21. 21. THANK YOU 1. Tweet one thing you learned today 2. Link with me 3. Email me how you will make an impact on CNCDs in 2014 DrElvira@midego.com

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