non-communicable epidemic chronic diseases

1. SLMA Presidential Address
2009

2. Regional Health Situation 2007 - The challenges
• Strengthening Health System
Public Health
Funding
Equity
Human Resource Development
Heath Informatics
• Promoting a healthy life course
MDG
Malnutrition
STD
Immunization
• Addressing challenges in healthy environments
Water supply coverage
Sanitation
Climate change
Global Warming
Occupational Health
Food Hygiene
Disaster preparedness
• Tackling risk factors and preventing NCD
CVD
Tobacco
Mental Illness
Trauma
• Preventing controlling eliminating & eradicating communicable disease
TB
HIV
Respiratory Infections
Diarrhoeas
Dengu
Chikungunya
Strengthening Health System
Public Health
Funding
Equity
Human Resource
Development
Heath Informatics
Promoting A Healthy Life
Course
MDG
Malnutrition
STD
Immunization
Healthy Environments
Water supply
coverage
Sanitation
Climate change
Global Warming
Occupational Health
Food Hygiene
Disaster
preparedness
Tackling risk factors and
preventing NCD
CVD
Tobacco
Mental Illness
Trauma
Diabetes
Preventing controlling
eliminating & eradicating
communicable disease
TB
HIV
Respiratory Infections
Diarrheas
Dengue
Chikungunya

3. Communicable diseases
Group A
1.Cholera
2.Plague
3.Yellow Fever
Group B
1.Acute Anterior Poliomyelitis
2.Dengue Fever/Dengue Hemorrhagic
Fever
3.Diphtheria
4.Dysentery
5.Encephalitis
6.Enteric Fever
7.Food Poisoning
8.Human Rabies
9.Leptospirosis
10.Malaria
11.Measles
12.Rubella (German Measles)
13.Simple Continued fever of 7 days +
14.Tetanus
15.Typhus Fever
16.Viral Hepatitis
17.Whooping Cough
18.Tuberculosis

4. WHO List of non-communicable
diseases
• Cardiovascular diseases
• Stroke
• Cancer
• Diabetes
• Chronic obstructive pulmonary disorders
(COPD) or chronic respiratory diseases,
• Mental illness and
• Trauma

5. Epidemic Chronic Disease
• “Epidemic”
• Traditionally used in connection with infectious
diseases….they occurred in large no in a short
space of time and referred to as pandemics
when they occurred across continents.
• The non communicable diseases are even
larger in numbers but more “chronic”. Hence the
WHO recognises the term “Epidemic Chronic
Disease”

6. 9. NEOPLASM
12. DIABETES
15. MENTAL HEALTH
20. HYPERTENSIVE DISEASE
20. ISCHAEMIC HEART DISEASE
23. STROKE
44. TRAUMATIC INJURIES
46. PESTICIDES
Indoor Morbidity Statistics 2006 by Broad Disease Groups

7. Cardiovascular
Cancer
COPD
Trauma
HT / Stroke
Leading Cause of Hospital Deaths 2006

8. Differences between communicable
& non communicable diseases (NCD)
Communicable
• Single causative agent
• Sudden onset of
symptoms
• Responds to short
courses of treatment
Non communicable
• Multifactorial
• Gradual onset with long
course
• Requires prolonged care
& treatment
• Affects quality of life
• Linked to common risk
factors (tobacco, alcohol,
unhealthy diet, physical
inactivity & environmental
carcinogen)
The World Health Report of 1999 shows
that in 1998 NCD accounted for 77% of
global mortality and 85% of the global
burden of disease was from low and
middle income countries. The situation
worsens in 2008…

9. Chronic diseases include heart disease, stroke,
cancer, chronic respiratory diseases and diabetes.
Visual impairment and blindness, hearing
impairment and deafness, oral diseases and
genetic
disorders are other chronic conditions that account
for a substantial portion of the global burden of
disease.
From a projected total of 58 million deaths from all
causes in 2005, it is estimated that chronic
diseases will account for 35 million, which is
double the number of deaths from all infectious
diseases (including HIV/AIDS, tuberculosis and
malaria), maternal and perinatal conditions, and
nutritional deficiencies combined.

11. Changes in the last 50 years of
relevance to Societal Health
• Demographic transition
• Epidemiological transition
• Other factors
Industrialization, urbanization, westernisation,
dietary habits, sedentary life styles, stress, infant
& child survival, diagnosis & treatment, life
expectancy, socio-political changes, health
seeking behaviour, cost of health care,
expectations of outcome, access to information
litigation, easy communication

12. Factors reducing mortality
• Income growth leads to better …
• Improved medical technology –
• Public Health Programmes –
• Knowledge about health –
Drugs
Vaccine
Diagnostic
Potable water
Sanitation
Food regulation
Schools
Health Education
Food
Housing
Access to
healthcare

13. Factors influencing changes
Doctor – Patient interaction
• Dependence on
history, examination,
experience
• Paternalistic care
• More humane
personal care
• Belief & trust
→ Dependence on
investigation
→Partnership with doctor
→More ”commercialised"
delivery
→More suspicion &
litigation

14. Demographic transition in
Sri Lanka
Population pyramids 1981 and 2001
WHO Country Cooperation Strategy 2006 – 2011: Democratic Socialist
Republic of Sri Lanka(WHO, 2006)]

15. Epidemiological transition
WHO Country Cooperation Strategy 2006 – 2011: Democratic Socialist
Republic of Sri Lanka(WHO, 2006)]

16. Epidemiological transition
WHO Country Cooperation Strategy 2006 – 2011: Democratic Socialist
Republic of Sri Lanka(WHO, 2006)]

18. Symptomatic Disease
Deaths
Mild or No S/S
Non specific S/S
Difficult to diagnose
EARLY DISEASE
RISK FACTORS

19. Let us look at some of the key illnesses
which are increasing in epidemic proportions
globally, regionally and locally causing
chronic ill health
1.Diabetes
2.Hypertension
3.Obesity
4.Metabolic Syndrome
5.Cardiovascular Disease
6.Cancer
7.Chronic Kidney Disease

20. 1. Diabetes – Definitions
Stage of hyperglycaemia Venous plasma
glucose
mmol/l (mg/dl)
Diabetes mellitus
• Fasting
• 2h post glucose load or random
blood sugar
>7.0 (126)
> 11.1 (200)
Impaired glucose tolerance (IGT)
• 2h post glucose load 7.8-11 (140-199)
Impaired fasting glucose (IFG)
• Fasting 5.6-6.9 (100-125)
Normal
• Fasting
• 2h post glucose load
<5.6 (100)
<7.8 (140)

21. Diabetes Global Situation
246 million worldwide
Diabetes atlas 2006, International Diabetes Federation
TYPE II DIABETES
According to the recent estimates of the International Diabetes
Federation (IDF), the global prevalence of diabetes among those
between 20 to 79 years of age was 6.6% amounting to 246 million
people. This figure is expected to increase to 7.3% (380 million) in
2025.

23. Diabetic epidemic in Sri Lanka
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1990 1994 2000 2004 2005 2006
Illangasekera, U. et al CMJ, 1993, Illangasekera, U. et al J R Soc Health, 2004, Fernando, D.J. et al Postgrad Med J, 1994,
Mendis, S. Et al Int J Cardiol, 1994, Malavige, G.N., et al., Diabetes Res Clin Pract, 2002, Wijewardene, K., et al., CMJ 2005,
Katulanda, P., et al, Diab Med 2006

25. Implications of diabetes in young adults
• Among Sri Lankans between 20 – 30 and 30 -
40 years 1.3% and 6.4% have diabetes mellitus
• Conservatively >200,000 patients with diabetes
between 20 – 40 years
• Implications of diabetes related morbidity among
the young adult diabetic subjects are
considerable
Katulanda P, PGIM oration 2008

27. 2. Hypertension…SLHS GUIDELINES 2005
BLOOD PRESSURE
(mmHg)
Other Risk Factors & Disease History
Level I. no other risk
factors
II. 1-2 risk
factors
III. 3 or more risk factors or TOD
or diabetes or ACC
Grade1
SBP140-159
or
DBP 90-99
LOW RISK
Life style
modifications
3-6 months
MED RISK
Life style
modifications
1-3 months
HIGH RISK
Life style
modifications
Immediate drug
therapy
Grade 2
SBP 160-179
or
DBP 100-109
MED RISK
Life style
modifications
1-3 months
MED RISK
Life style
modifications
1-3 months
HIGH RISK
Life style
modifications
Immediate drug
therapy
Grade 3
SBP 180
or
DBP 110
HIGH RISK
Life style
modifications
Immediate drug
therapy
HIGH RISK
Life style
modifications
Immediate
drug
therapy
HIGH RISK
Life style
modifications
Immediate drug
therapy

28. • 90% of whose BP was normal (<140/90) at 55
years ultimately developed hypertension in their
life time.
• Risk of CVS disease increased progressively
from 115/75 with doubling of the incidence of
both coronary heart disease and stroke for every
20mmHg systolic / 10mmHg diastolic increment
of blood pressure
JNC7 introduced Pre Hypertension
This entity is of public health
importance as it adds to the burden of
hypertensive population ; Therefore
Annual & 6 monthly screening of BP is
advised

29. Hypertension – magnitude of the
problem
• Hypertension is the commonest risk factor for
the commonest death in adults.
• In 1990 5.8%
• In 2000 7.2% …increasing worldwide
• By 2020 Hypertension will be the most common
risk factor for death and disability globally
• National Prevalence Survey –
WB / MOH 2000 studied WP/NCP/SP/Uva
Age Group 30 – 65 Years. Height , Weight, Waist, BP
Wijewardene, Mohideen et al 2005 in 4 provinces on 6047 individuals
Showed a prevalence of Males 19.4% Females 20.6%

30. 1990
5.8%
Worldwide deaths due to
hypertension
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL. Selected major risk factors and global and regional burden
of disease. Lancet 2002:360; 1347-60
2000
7.2%

31. 0 1000 2000 3000 4000 5000 6000 7000 8000
Indoor air pollution
Alcohol use
Physical inactivity
Overweight & Obesity
Low fruit & veg intake
Unsafe sex
Child underweight for age
High cholesterol
Smoking
High blood pressure
Attributable deaths (000s)
Mortality due to leading risk factors, 2001
Alan D Lopez, Colin D Mathers, Majid Ezzati, Dean T Jamison and Christopher JL Murray. Global and regional burden of disease and
risk factors, 2001: systematic analysis of population health data. The Lancet, Volume 367, Issue 9524, 27 May 2006-2 June
2006, Pages 1747-1757

32. Measure n (95% CI)
Total number worldwide in 2000 972 million
Total number in economically
developed countries in 2000
333 million
Total number in economically
developing countries in 2000
639 million
Total number worldwide in 2025 1.56 billion
Kearney PM et al. Lancet 2005; 365:217-223
Estimated total number of adults with
hypertension

34. 0
100
200
300
400
500
600
700
800
900
1000
1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010
rateper100,000population
Diabetes Hypertension IHD
Projected increase of Hospitalisation due to
Diabetes, Hypertension and IHD
Premaratne R et al. Hospitalisation trends due to selected non-communicable diseases in Sri Lanka, 2005-
2010. Ceylon Medical Journal. 2005 June; 50( 2):51-4.

35. Trends in mortality from Hypertension and
Cerebrovascular disease
1980-1995 – Sri Lanka
0
5
10
15
20
25
1980 1985 1987 1989 1991 1992 1995
Agespecificdeathratesper100,000
pop
Hyp-Males Hyp-Females Cerebrovascular-Males Cerebrovascular-Females
Source: http://www.who.int/healthinfo/morttables/en/index.html

36. USA
27.4
Canada
16.0
Australia
7.0
Finland
20.5Scotland
17.5
Germany
22.5
Spain
15.5
France
27.0
England
6.0
India
9.0Zaire
2.5
Italy
23.4

37. Adequacy of blood pressure control –
Sri Lankan study
Systolic control
24%
3065 males and females, mean age 59 years, 3 centres
in Sri Lanka
Diastolic control
51%
Both systolic & diastolic
22%

38. Males
19.4%
Females 20.6%
Prevalence of
hypertension

39. Year
Age
group
Criteria Location Number
Prev
Males
Prev
Females
Total
1985
30 &
over
160/95
*Baddegama
(rural)
357
Not
available
Not
available
10%
1991 35-59 160/95
#Central
Province
975
17%
(urban)
8% (rural)
14.90%
1992 30-80 160/95
**Bope-
Poddala
(semi-urban)
619 22.30% 32% 26.60%
1986
25 &
over
160/90
§Galle-Fort
(urban)
203 38.80% 32.80% 35.50%
1991
Not
available
Not
available
***Rural (Indigenous)
Not available
5.70% 1.90%
Not
available
* Mohideen MR, Hettiarachchi J. Utilization of family health workers in screening for hypertension in a rural community in Sri Lanka. Ceylon Medical Journal
1985; 30: 97-101
# Mendis S, Ekanayake EM. Prevalence of coronary heart disease and cardiovascular risk factors in middle aged males in a defined population in central Sri
Lanka International Journal of Cardiology 1994, 46:135-142P
**Mohideen MR., Amerasinghe M.,.Abeykoon B,.Abeyratne DM, Anurakumara LHI.. Epidemiology of hypertension in Galle. Abstracts of the 105th Anniversary
Academic Sessions of SLMA, March 1992.
§Hettiarachchi J, Mohideen MR Hypertension in an urban community in Sri Lanka. Abstracts of the 99th anniversary academic sessions of SLMA. Colombo,
March 1986.
***Mendis S. Coronary heart disease and coronary risk profile in a primitive population. Tropical Geography Mediicne. 1991 ;43(1-2):199-202.
Prevalence of hypertension in previous
studies

40. Katulanda et al., Unpublished data (Sri Lanka Diabetes and CVD Study)
Prevalence of hypertension
N = 4532

41. Prevalence of prehypertension
Systolic blood pressure - 120 to 139 mm Hg and
Diastolic blood pressure - 80 and 89 mm Hg
0
5
10
15
20
25
30
35
30-35 36-40 41-45 46-50 51-55 56-60 61-65
Males Females
Male prevalence 25.2% ;Female
prevalence: 19.8%

42. Drinkers Non drinker p
Hypertension
26.8%
(90) 16.6% (446) <0.001
Mean SBP
(mmHg) 124.6 118.9 <0.001
Mean DBP
(mmHg) 77.6 73.4 <0.001
Blood pressure and drinking
status

43. Males Females
Diabetes 14.9% 13.9 %
Impaired fasting glucose 14.1% 14.1%
Obesity 20.3% 36.5%
Prevalence of other risk factors
National Prevalence Survey
Wijewardena K, Mohideen MR, Mendis S, Fernando DS et al. Prevalence of hypertension, diabetes and obesity: baseline
findings of a population based survey in four provinces in Sri Lanka. Ceylon Medical Journal 2005; :62-70

44. Males Females
Cigarettes 46.2%
Beedi 14.5%
Cigars 3.2%
Prevalence of smoking
National Prevalence Survey
Overall prevalence – 51%
Only 7
smokers

45. Hypertensive
(%)
Prehypertensive
(%)
Normotensive
(%)
Males
Obese 310 (57.8) 489 (64.1) 1324 (76.6)
Normal 226 (42.2) 274 (35.9) 404 (23.4)
Females
Obese 458 (63.6) 385 (52.2) 986 (43.2)
Normal 262 (36.4) 352 (47.8) 1297 (56.8)
Prevalence of hypertension in relation to obesity

46. 3. Obesity
WHO GLOBAL RECOMMENDATION PROPOSED CUT-OFF LEVELS FOR
ASIANS
BMI CATEGORY BMI CATEGORY
< 16 KG/M2
SEVERE
UNDERWEIGHT
16.0 – 16.9 KG/M2
UNDERWEIGHT
17.0 – 18.49 KG/M2
MILD
UNDERWEIGHT
< 18.5 KG/M2
UNDERWEIGHT
18.5 – 24.9 KG/M2
NORMAL RANGE 18.5 – 22.9 KG/M2
NORMAL RANGE
25.0 – 29.9 KG/M2
PRE OBESE ≥ 23 - 27.4 KG/M2
PRE OBESE
30.0 – 34.9 KG/M2
OBESE CLASS I ≥ 27.5 KG/M2
OBESE
35.0 – 39.9 KG/M2
OBESE CLASS II
≥ 40 KG/M2
OBESE CLASS III
WHO (2000) World Health Organ Tech Rep Ser, 894, i-xii, 1-253. WHO (2004) Lancet, 363, 157-63.

47. Prevalence of generalised obesity
P <0.0001 Male vs. Female
25.0 22.4 23.6
44.9
37.1
40.8
22.9
28.6
25.9
7.2 12.0 9.7
0%
20%
40%
60%
80%
100%
Male Female All
Prevalence
≥27.7
23-27.4
18.5-22.9
<18.5
Katulanda et al., Unpublished data (Sri Lanka Diabetes and CVD Study)

48. Prevalence of central adiposity
30.1
56.0
43.4
14.1
36.1
25.6
17.4
40.1
29.2
0
10
20
30
40
50
60
Male Female All Male Female All Male Female All
Urban Rural All
Prevalence
Central obesity – male ≥90cm; female ≥80cm
Katulanda et al., Unpublished data (Sri Lanka Diabetes and CVD Study)

50. 4. Metabolic syndrome
• Clustering of risk factors of CVD together more commonly
than would have occurred by chance
• These factors are central obesity, dysglycaemia, low HDL-C,
elevated triglycerides (TG) and high blood pressure and some
markers of low grade inflammation
• Different names given to this phenomenon (Syndrome X,
dysmetabolic syndrome & metabolic syndrome)
• The International Diabetes Federation (IDF) has promoted a
worldwide consensus on the terminology and definition (also
supported by many other organisations)
Alberti, K. G.et al Diabet Med, 23, 469-80.

51. Metabolic Syndrome - real or not?
• One school of thought believes Metabolic Syndrome is
real and exists. It is a useful concept in understanding
the interaction of multiple risk factors for CVD and hence
in fine tuning management in an individual.
• Another school believes that there is no single entity
called Met Syndrome and attention needs to be directed
at individual risk factors.
• I support the former as it is useful in Public Health
interventions and population strategies in addition.

52. IDF criteria for Metabolic
SyndromeCentral obesity
Waist circumference – ethnic specific (male >90 and female>80)
Plus any two of the following
Raised triglycerides ≥1.7mmol/l (150mg/dl)
Specific therapy
Reduced HDL-Cholesterol <1.03 mmol/l (40mg/dl) males
<1.29 mmol/l (50mg/dl) females
Raised blood pressure Systolic ≥130mmHg or diastolic ≥ 85mmHg
Or treatment of previously diagnosed hpt
Raised plasma glucose Fasting plasma glucose ≥5.6 mmol/l †(100mg/dl) or previously
diagnosed T2DM
Alberti, K. G.et al Diabet Med, 23, 469-80.

53. Prevalence of Metabolic Syndrome
11.10 %
2 3 .6 0 %
18 .70 %
0%
4%
8%
12%
16%
20%
24%
M a le F e m a le O v e ra ll
P <0.001 (Male vs Female)
Katulanda et al., Unpublished data (Sri Lanka Diabetes and CVD Study)-n=4532

54. 2 8 .70 %
17.10 %
5.9 0 %
18 .70 %
0%
4%
8%
12%
16%
20%
24%
28%
32%
Urba n R ura l P la nta tio n O v e ra ll
Metabolic Syndrome according to the sector of
residence
Katulanda et al., Unpublished data (Sri Lanka Diabetes and CVD Study)

55. DM
PREDIABETES
METABOLIC SYNDROME
Central Obesity
Insulin Resistance (IR)
Hypertension
Hyperlipidaemia
CAD, DM type 2 WHO 1998, IDF 2005

56. 5. Cancer
• 6 million deaths from Cancer each year.
• 50% due to CA lung, stomach, colon, rectum,
liver, breast.
• Tobacco causes 3 million deaths and smoking
accounts for 1 in 7 cancer deaths.
• Avoid carcinogens
• Early detection – Screening Treatment.
• Emerging evidence that some cancers are
associated with lifestyle eg Smoking (Lung
Upper GI), Obesity(Colon Breast),Sedentary
lifestyle (Breast).

58. 6. Cardio - Vascular Disease
• Coronary Heart Disease – leading COD in Sri Lankan
Hospitals – can be
• Modifiable Risk factors -
» Smoking
» High Blood Pressure
» Diabetes
» High serum cholesterol
» High LDL levels
» Obesity
» Diet - high saturated fat intake
» ? Stress
controlled
avoided
treated
genetic /
environmental
component

59. 7. CKD in Asia (defined as GFR
<60mls/min/1.7m2
)
• CKD – increasing worldwide .Recognised as a public
health problem.
• ESRD and CVD when occurring together leads to
adverse outcomes
• Asia has high incidence of CKD
• Diabetes major causative factor for CKD
• High prevalence amongst family members
Malaysia 57.5%
India 42%
Taiwan 39.5%
Thailand 31.5%
Japan 20%
Singapore 17.7%

60. ACUTE ILLNESS
• RENAL COLIC
• ACUTE PYELNEPHRITIS
• ACUTE RENAL FAILURE
• ACUTE NEPHRITIS
• SURGICAL TRAUMA
• ACUTE TUBULAR
NECROSIS
• SNAKE BITES
• POST PARTUM
• PROSTATE
• TRAUMA
• DRUG INDUCED
CHRONIC ILLNESS
• DIABETIC NEPHROPATHY
• HYPERTENSIVE
NEPHROSCLEROSIS
• OBSTRUCTIVE
NEPHROPATHY
• INTESTITIAL NEPHRITIS
• INFECTIVE / RENAL TB
• DRUG INDUCED
• CONGENITAL –
POLYCYSTIC KIDNEYS
• CANCER OF THE KIDNEYS

61. CKDu epidemic in Sri Lanka
• NWP, NCP, Uva
• Increasing number of deaths
• Physicians noticed the main cause of death has
changed from IHD to ESRD deaths
• Ministry setup many clinics
• Some areas more prevalent
• Public, Press, Politicians – are vocal
• Over & above CKD due to hypertension, Diabetes,
& Urological disease
• Public Health Problem
• Environment toxin likely
• Various theories floated Fluoride, Cadmium, Water
contamination (heavy metals, Organophosphates)
NEEDS PLANNED STUDY

62. National Research Programme for
CKDu
• An internationally agreed case definition
• Systematic Survey to identify low and high risk CKDu
areas / GIS mapping
• Hospital based CKD registry.
• Histology
• Comprehensive screening / analysis
Soil, Water, Rice, Fish Blood, Multi element studies
• Sociology / Diet studies
• Vegetation, Animal studies
• Other studies
• Provided funds permit / Prioritized
-Post mortem
-Review of historical slides
-Renal biopsy studies

64. CKDu
Case Definition … NKDOQI modified
1. No P/H or current treatment for
2. Normal HbA1c <6.5%
3. BP <160/100 untreated or <140/90 on up to 2
antihypertensives
-DM
-Chronic or Severe HPT
-Snake bite
-Urological disease
-Glomerulonephritis
CKD 1 ACR ≥ 30mg/g + eGFR >90
CKD 2 Persistent albuminuria eGFR 60-89
CKD 3 eGFR 30 – 59
CKD 4 eGFR <30
CKD 5 eGFR <15

65. ?How do we reduce the
chronic disease
burden

66. PREVENTION AIM TARGET
Primordial Underlying
conditions leading
to exposure to
causative factor
Total population
or selected
groups
Primary Limit incidence by
controlling causes
& risk factor
Total population
High risk
individually
Secondary Cure and reduce
serious
complication
Early detection
and treatment
Tertiary Reduce progress
of complications
Therapeutic &
Rehabilitative

67. • Primordial prevention
Aim : reduce - leading causes of disease/ contribute to
elevated risk
- Avoid diet with high saturated animal fat
- Discourage smoking
- Promotion of regular physical activity
- Promotion of healthy eating
• Primary prevention
Aim : limit incidence – control causes & risk factors)
- Lowering cholesterol
- Reducing urban air pollution
- Stopping smoking / passive smoking
- Wearing seatbelts
• Screen for cancer of cervix
• Use of condoms

68. • Secondary prevention
Aim : cure, detect early & treat
• Detect and treat hypertension
• Detect and treat diabetes
• Tertiary prevention
Aim : reduce disability & minimise suffering)
• Laser therapy to prevent/treat blindness
• Stroke Rehabilitation

69. Prevention of chronic disease
a) Population based approaches
- Legislation (Tobacco, Food Labeling)
- Policy (Healthy eating - Canteen policy in Schools)
- City Planning (Walking & Exercise areas for the community)
- Education (School curricula, Teacher training)
- Social Marketing / Health promotion
b) Individual based approaches
- High risk
- Smoking
- Exercise
- Alcohol
- Stress
- Diet + Saturated Fats
- Drugs
BP
DM

70. Epidemiological AssessmentEpidemiological Assessment
Awareness generation & high-level advocacyAwareness generation & high-level advocacy
Development of policy & strategic planDevelopment of policy & strategic plan
Capacity strengthening, resource mobilization
and infrastructure development
Capacity strengthening, resource mobilization
and infrastructure development
Multisectoral & multilevel action
to modify environment
Multisectoral & multilevel action
to modify environment Health sector interventionsHealth sector interventions
Population decrease in
NCD risk factor level and
Reduced adverse health events
Population decrease in
NCD risk factor level and
Reduced adverse health events
Reduced health & economic burden of NCDReduced health & economic burden of NCDReduced health & economic burden of NCD
MOH/ Epidemiology Department
SLMA / MOH / Specialist Societies
MOH / WHO
MOH
MOH / PROFESSIONAL BODIES / CLINICIANS
Service Delivery Points / Primary Care Giver / Private Sector

71. ?How can SLMA
help as an apex
medical professional
organisation

72. SLMA COMMITTEES
•Communicable Diseases
•Drugs
•Ethics Review Committee
•Ethics
•Food & Nutraceuticals
•Getting Research into Practice (GRIPs)
•Health Care Waste Management
•Health Management
•Media Social Activities
•Medical Education
•Membership
•Mental Health
•National Health Policy
•Non Communicable Diseases
•Prevention of Motor Traffic Accidents
•Central Continuing Professional Development Committee
•Snake Bite
•Tobacco, Alcohol and Illicit Drugs
•Women's Health

73. Health Equity
• Commission on Social Determinants of Health in 2005
- Setup by WHO
- To promote equity in health
Conclusion :
Much of the Global burden of disease is avoidable &
unacceptable
• 1968 WHO Alma – Ata declaration
‘Health for all by year 2000’
Millennium Development Goals
Expression of need for social justice
Some low income states like Costa Rica, Kerala, Sri Lanka have achieved a level
of good Health & equitable Health without high national wealth
Poor social policies
Unfair economic arrangements
Bad politics
Unequal distribution
Power
Income
Goods
Services
‘Toxic’
Combination

74. Health Equity – Clinicians have a key
role to play
• Chronic disease management with an additional
focus on empowering the patient and use him or
her for prevention in the community.
• Individually and as professional organizations
we can act as advocates and agents of social
change
• SLMA doctors over 120 years have done
yeoman service to achieve what we have. There
is more work to be done

75. Acknowledgements
• All my house officers, registrars, senior registrars,
departmental colleagues.
• For preparation of this talk Dr Prasad Katulanda,
Professor Chandrika Wijeratne, Professor Rifdy
Mohideen,Prof Ravindra Fernando, Dr Eranga,
Dr Sanjaya, Epidemiology Unit (MOH), Professor
Shanthi Mendis
• Special Thanks to the energetic Dr Ruvaiz Haniffa
• To Mr Rajasingham & Staff of the SLMA and PGIM
• My Son Dr Rikaz Sheriff for his IT input.
• My wife Ameena and family.
• To Allah for this opportunity.
• To all others who have helped me in various ways…

76. untitled.JPG