CCIH 2012 Conference, NCD Pre-Conference, Jeffrey Meer, Global Epidemiology of Non-Communicable Diseases
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Jeffrey Meer, Special Advisor for Global Health at the Public Health Institute, discusses the toll of non-communicable diseases on the developing world and what civil society can do, and dispels common myths.
![What are NCDs?
• Cardiovascular Disease
• Cancers
• Diabetes
• Chronic Obstructive Pulmonary Disease
• [Mental Health]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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CCIH 2012 Conference, NCD Pre-Conference, Jeffrey Meer, Global Epidemiology of Non-Communicable Diseases
- 1. Global Epidemiology of NCDs (Part I) Jeffrey Meer Christian Connections for Special Advisor International Health for Global Health 26th Annual Conference June 8, 2012 Arlington, VA
- 2. What are NCDs? • Cardiovascular Disease • Cancers • Diabetes • Chronic Obstructive Pulmonary Disease • [Mental Health]
- 3. Context • NCDs are responsible for 63 percent of all deaths globally. • NCD deaths are projected to increase by 15% globally between 2010 and 2020
- 4. Causes of Death in Rural Bangladesh Courtesy Richard Smith, MD
- 5. DALY = Disability Adjusted Life Year a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
- 6. Burden of Disease 2004 - 2030 Courtesy: Richard Smith, MD
- 7. Common Risk Factors • Smoking Tobacco • Inappropriate use of alcohol • Inadequate exercise • Poor nutrition
- 8. The NCD Pyramid Courtesy: Richard Smith, MD
- 9. What Else Affects NCDs? • Genetics • Environment • Lifestyles
- 10. Myths about NCDs • Less common than infectious diseases (HIV, TB, malaria, diarrhea) • Unrelated to infectious diseases • Only for the rich and aged • Too expensive and complex to treat • Take $ and focus away from infectious diseases
- 11. 19 Leading Factors in Deaths (2004) Courtesy: Richard Smith, MD
- 12. Development Implications • Premature death • Disability • Loss of productivity • Cost of treatment and care
- 13. NCD Civil Society Organizing • Non Communicable Disease (NCD) Alliance • Global Health Council NCD Roundtable • NCD Child
- 14. Resources? Less than 3 percent of all international development assistance for health ($21 billion annually) goes to NCD prevention or treatment
- 15. NCD Prevention and Treatment Matter! US death rates from several diseases 1900-1996 Courtesy: Richard Smith, MD
- 16. A Global Problem • Global Status Report on NCDs 2010 (WHO) • www.ncdalliance.org • www.ncdchild.org
Editor's Notes
- Very happy to be here, and appreciate Ray Martin and Mona Bormet’s hard work to make this a reality.
- WHO definition Others include: Mental illness Disabilities Allergies Injuries including from road traffic accidents Burns Birth Defects
- In 2010, caused roughly 36 million deaths, 80% of which are in developing countries. By 2030, NCDs will be responsible for 75 percent all deaths. Growing fastest in Africa, South-East Asia and the Eastern Mediterranean, where they will increase by over 20%. The regions that are projected to have the greatest total number of NCD deaths in 2020 are South-East Asia (10.4 million deaths) and the Western Pacifi c (12.3 million deaths) From “WHO Global Status Report on NCDs 2010.”
- Courtesy Richard Smith, MD, former editor British Medical Journal. In the United States, everyone knows someone with one of these four groups of illnesses. One of world’s oldest and most complete demographic survey’s Matlab has charted births and deaths since 1966 in 17 countries. Here are data representing male deaths in Bangladesh from 1974 to 2006.
- Public Health community uses DALY to measure the cost to societies of various illnesses and conditions.
- According to WHO projections. For example, COPD to go from 2.0 percent of total DALYs (rank 13), to 3.8 percent of DALYs (rank 5). Diabetes from 1.3 percent of DALYs (rank 19) to 2.3 percent of DALYs (rank 10) Ischemic heart disease from 4.1 percent of DALYs (rank 4) to 5.5 percent of all DALYs (rank 2). New WHO Study (June 2012) notes that middle income countries (China and India) may see cancer rates increase by 78 percent by 2030; less developed countries rise by 93 percent.
- Framework convention on Tobacco Control Tobacco now used by 20 percent worldwide. More than one billion people smoke every day. Alcohol: WHO estimates that 2.3 million people died in 2004 from harmful use of alcohol, by itself responsible for 3.8 percent of all global deaths (cancer, cardiovascular disease, and cirrhosis of the liver. Inadequate exercise: for the first time in human history in 2010 more people lived in cities than outside of them. In Surinam, kids aged 13-15, 73 percent get less than 1 hour per day of exercise on average Nutrition: salt, sugar, trans-fat Changes in diet from fresh food to prepared In Chad, only 3 percent regularly eat fresh fruit/vegetables
- From Dr. Richard Smith, former editor of the British Medical Journal. Metabolic: Number of people with hypertension grew from 600 million in 1980 to 1 billion in 2008. Worldwide some 2.8 million people die each year from being overweight including obesity Social determinants include education and poverty. Singapore, eg, the prevalence of physical inactivity, daily smokuing and regular consumption of alcohol was consistently highest among men and women with least education. (Fong, CW Sinapore Medical Journal, 2007). Childhood SES is associated with type II diabetes and obesity in later life. (Tamayo and Rathman, BioMed Central Public Health, 2010).
- Genetics: just beginning to get data on this. Of particular relevance, clear linkages with risk of cervical cancer and some risk for breast cancer (source: national cancer institute) Environment: includes, for example, indoor air pollution. Begins in utero and continues throughout the life cycle. About half of the world uses cookstoves with harmful levels of particulates. Lifestyles: massive movements from agrarian to urban (2009 first time in human history majority live in cities) accompanied by sedentary lifestyle; changes in diet and increased consumption of high fat, sugary, salty, processed foods
- Total deaths from CV Disease, CL disease, diabetes, cancer are 32 million deaths. From HIV, malaria, TB are 4.3 million. With the exception of the African Region, NCD mortality exceeds that of communicable, maternal, perinatal and nutritional conditions combined. For men in the European Region, deaths from NCDs are estimated to be 13x higher than these other causes combined, and for men in the Western Pacific Region they are estimated to be 8x higher. Connections with infectious disease: examples human pappiloma virus and cervical cancer. Epstein-Barr virus and Burkett’s lymphoma, strep infectious and rheumatic heart disease. 80 percent of NCDs now in the developing world and growing. Mowing down people in their most productive years. in low- and middle-income countries, 29% of NCD deaths occur among people under the age of 60, compared to 13% in high-income countries. Prevention can eliminate 50 percent of CV deaths, 1/3 to ½ of all cancers, up to 50 percent of adult-onset diabetes, and most chronic obstructive pulmonary disease. Stopping some infections that cause chronic diseases can be done as no-cost add ons to existing programs. Diabetes can be treated for pennies per day with insulin that has been around for 90 years.
- Amplifying point about this problem is not limited to developed countries. This chart uses data from WHO. See especially the significant behavioral factors (tobacco, inactivity, alcohol use, low fruit/vegetable consumption) in low and middle income countries
- IDF estimates that diabetes will cause US $378 billion in global healthcare spending in 2010 – equivalent to 12% of global healthcare expenditure. This is predicted to increase to USD490 billion by 2030. Between 2005 and 2015, WHO estimates that China, Russia and India will lose US $558 billion, US $303 billion and US $237 billion respectively in foregone national income as a result of largely preventable deaths from diabetes, heart disease and stroke. WEF study by David Bloom says costs of not treating NCDs over next 20 years exceed $47 trillion (includes very large component of mental health). Represents around 4 percent of global GDP. Left prevented, NCDs can occupy an enormous percentage of Ministry of Health budgets.
- Probably about 2,000 groups in all.
- Source: Rachel Nugent, U of Washington.
- Richard Cooper, MD, Loyola University: FIGURE 6 Increase and Decline in Heart Disease Rates through the Epidemiological Transition in the United States (1900 to 1996) In the 1930s and ’40s, smoking and fat consumption continued to rise, as did the prevalence of heart disease. The U.S. had entered the third phase of the epidemiologic transition, the Age of Degenerative and Man-Made Diseases. By 1955, 55 percent of adult men were smoking, and fat consumption represented about 40 percent of total calories. Americans were also becoming more sedentary as a result of continued mechanization and urbanization and the rise of the suburbs after World War II, where more people were driving instead of walking and bicycling. Another important development affecting the health of Americans post WWII was the growth of the healthcare industry. By the late 1950s, more than 2/3 of the working population had some form of private insurance (7). As the 1960s progressed, age-adjusted CVD mortality rates began to decline, marking the beginning of the fourth phase of the transition, the Age of Delayed Degenerative Diseases. Since then, there have been substantial reductions in rates of mortality from both stroke and CHD. This decline can be attributed primarily to two main factors, therapeutic advances and prevention measures targeted at people with CVD as well as those potentially at risk for it. (8-10) Interestingly, healthier lifestyles may have actually had an even greater impact on the decline in age-adjusted rates of death. For example, improvements in diet due to access to fresh fruits and vegetables year round in developed countries may have contributed to declining cholesterol mean levels before effective drug therapy was widely available. (1) Starr, P: The Social Transformation of American Medicine . New York: Basic Books; 1982. (2) Goldman L, Cook EF: The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med 1984, 101:825. (3) Hunink MG, Goldman L, Toteson, AN, et al: The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment. JAMA 1997, 277:535. (10) Cooper R, Cutler J, Desvigne-Nickens P, et al: Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation 2000, 102:3137.
- Now you are going to hear from Dr. Synnove Knutsen about the Adventist Health Study, lessons learned to date on lifestyle impacts on health outcomes, and any evidence of relevance of religion and faith to healthy lifestyles.