Philippine Perspectives: Noncommunicable Diseases, Risk Factors and Health Inequalities
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Presentation delivered at the pre-convention workshop of the 21st Annual Convention of the Philippine Ambulatory Pediatric Association, Inc.
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Philippine Perspectives: Noncommunicable Diseases, Risk Factors and Health Inequalities
- 1. Albert Francis E. Domingo, MD, MSc Consultant, Noncommunicable Diseases and Health Promotion Unit 8 March 2016 Philippine Perspectives:
- 2. Noncommunicable Diseases, Risk Factors and Health Inequalities2 | Healthy population Population at risk Population with sickness Sick that need hospitalization but have no access to hospital care Sick and Hospitalized
- 3. Forces of nature, war, and legal intervention Self-harm and interpersonal violence; unintentional injuries; transport injuries Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; cardiovascular diseases; chronic respiratory diseases; neoplasms Mental and substance use disorders Other NCDs Nutritional deficiencies Maternal and neonatal disorders HIV/AIDS and TB Diarrhea, lower respiratory, and other common infectious diseases 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Causes of Death over the Life-Course in the Philippines (2013, both sexes) Other communicable, maternal, neonatal, and nutritional diseases Neglected tropical diseases and malaria Data from the Global Burden of Disease (2013) as published in The Lancet days years
- 4. Noncommunicable Diseases, Risk Factors and Health Inequalities4 | The NCD Causation Pathway Underlying determinants • Globalization • Urbanization • Population ageing • Social determinants Common risk factors •Tobacco use •Unhealthy diet •Physical inactivity •Harmful use of alcohol •Air pollution •Age & heredity (non- modifiable) Intermediate risk factors • Raised blood sugar • Raised blood pressure • Abnormal blood lipids • Overweight/obesity • Abnormal lung function Diseases • Cardiovascular disease • Cancer • Diabetes • Chronic respiratory disease Adapted from WHO (2005) Preventing Chronic Disease: a Vital Investment.
- 5. Noncommunicable Diseases, Risk Factors and Health Inequalities5 | Early life environmental exposures can lead to later-life health problems Maternal toxic exposures oxidative stress Low birth weight Cardiovascular disease and Diabetes Alzheimer’s, Dementia, Parkinson’s
- 6. Noncommunicable Diseases, Risk Factors and Health Inequalities6 | Who is/are the patient(s)? What are the diagnostics and therapeutics? Figure from: GBD 2013 Risk Factors Collaborators (2015)
- 7. Noncommunicable Diseases, Risk Factors and Health Inequalities7 | • NCDs and their risk factors start in higher socioeconomic status (SES) and in urban areas • Those of higher SES respond to prevention campaigns first
- 8. Noncommunicable Diseases, Risk Factors and Health Inequalities8 | • Those of lower SES continue to experience increasing NCDs • The double burden of disease (noncommunicable and communicable) will further deplete scarce resources • Those of lower SES are at risk of receiving inadequate care
- 9. Noncommunicable Diseases, Risk Factors and Health Inequalities9 | Epidemiological Transition 0 10 20 30 40 50 60 70 80 90 100 110 0 100 200 300 400 500 600 1954 '57 '60 '63 '66 '69 '72 '75 '78 '81 '84 '87 '90 '93 '96 '99 '02 '05 2008 Deathsper100,000population (non-communicablediseases) Deathsper100,000population (communicablediseases) Year Communicable Diseases Malignant Neoplasm Diseases of the Heart Source: Philippine Health Statistics, various years
- 10. Noncommunicable Diseases, Risk Factors and Health Inequalities10 | Philippine Data Source and Methods 2003 National Nutrition and Health Survey – National; stratified, three-stage random sampling; n=3,307 – 97% response rate – 20-65 years of age; 52.2% men, 47.8% women Analysis done by the Food and Nutrition Research Institute Socioeconomic Status (SES) variables: – Education (primary, secondary, at least tertiary) – Annual household income • Low: PhP <= 53,064; Medium: PhP 53,065-92,192 • High: PhP 92,193-173,387; Very high: PhP >= 173,388
- 11. Noncommunicable Diseases, Risk Factors and Health Inequalities11 | From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
- 12. From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
- 13. From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
- 14. Noncommunicable Diseases, Risk Factors and Health Inequalities14 | From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
- 15. Noncommunicable Diseases, Risk Factors and Health Inequalities15 | From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
- 16. Noncommunicable Diseases, Risk Factors and Health Inequalities16 | How to Respond Enhance and improve early childhood development programs and education for all social groups Remove barriers to secure employment Tax tobacco and alcohol, regulate their production and sales, and restrict advertising and marketing Reduce dietary salt intake by regulation, education, and mass media campaigns for the marginalized Adapted from: Di Cesare (2013) Inequalities in non-communicable diseases and effective responses. The Lancet.
- 17. Noncommunicable Diseases, Risk Factors and Health Inequalities17 | How to Respond Improve financial and physical access to healthier diets (fresh fruits and vegetables, healthy fats, whole grains, etc.) Implement universal, financially and physically accessible, high-quality primary care to reduce risk factors; enhance early detection and treatment of NCDs Remove financial barriers to health care, reduce physical and behavioural barriers to health care use, and improve the quality of care especially in disadvantaged communities Adapted from: Di Cesare (2013) Inequalities in non-communicable diseases and effective responses. The Lancet.
- 18. 2025 milestone: 9 voluntary global NCD targets By 2030, reduce by one third premature mortality from NCDs 2030 milestone: NCD-related targets in the SDGs 2018 milestone: Four time-bound commitments WHO Global NCD Action Plan 2013- 2020 2011 UN Political Declaration on NCDs 2014 UN Outcome Document on NCDs Governance Risk factors Health systems Surveillance Components of national NCD responses WHO Regional NCD Action Plans Getting to 2030: Global vision Sustainable Development Goals
- 19. Noncommunicable Diseases, Risk Factors and Health Inequalities19 | HEALTH AND THE ENVIRONMENT Division of Noncommunicable Diseases and Health through the Lifecourse
Editor's Notes
- Our goal is to keep as many individuals as possible in the pink box of a healthy population. We seek to minimize the number who become at risk, who then become sick, and who are ultimately hospitalized.
- Maternal exposure to air pollution, including particulates, carbon monoxide, sulfur and nitrogen oxides, ozone, and tobacco smoke, are associated with low birth weight, congenital defects and fetal and neonatal deaths (1). Maternal air pollution exposure is also linked to child health effects including decreased lung growth, increased rates of respiratory tract infections, asthma, behavioral problems, and developmental (neurocognitive) impairments (1,2,3,4). Low birth weigh in turn is linked to obesity in teen years and adulthood (7,8). Many studies have also found low birth weight to be a risk factor for adult cardiovascular disease, hypertension and Type II diabetes. (5,6,7,8,9). And as noted previously, these diseases in midlife (especially diabetes) are associated with increased risk for the development of Alzheimer’s disease/dementia in later life. (1) Wang L. Air pollutant effects on fetal and early postnatal development (review) Pinkerton KE. Birth Defects Res C Embryo Today 2007 Sep; 81(3):144-54. (2) Brauer M et al. A cohort study of traffic-related air pollution impacts on birth outcomes. Environ Health Perspect. 2008 May; 116(5):680-6. Erratum in: Environ Health Perspect. 2008 Dec; 116(12):A519. (3) Perera FP et al. Effect of prenatal exposure to airborne polycyclic aromatic hydrocarbons on neurodevelopment in the first 3 years of life among inner-city children. Environ Health Perspect. 2006 Aug;114(8):1287-92. (4) Choi H et al. Prenatal exposure to airborne polycyclic aromatic hydrocarbons and risk of intrauterine growth restriction. Environ Health Perspect. 2008 May; 116(5):658-65. (5) Frankel T, Osmond C, Sweetman P, et al. Birth weight, body mass index in middle age, and incident coronary heart disease. Lancet 1996; 348:1478-1480. (6) Stein CF, Fall CHD, Kumaran K, et al. Fetal growth and coronary heart disease in South India. Lancet 1996; 348:1269-1273. (7) Rich-Edwards JW, Stampfer MJ, Manson JE. et al. Birth weight and risk of cardiovascular disease in a cohort of women followed up 1976. BMJ 1976; 315:396-400. (8) Leon DA, Lithell HO, Vâgerö D, et al. Reduced fetal growth rate and increased risk of death from ischaemic heart disease: cohort study of 15 000 Swedish men and women born 1915-29. BMJ, 1998; 317:241-5. (9) Simmons R. Perinatal programming of obesity. Seminars in Perinatology, 2008, 32, (5), 371-374.
- Mortality Trends of Communicable Diseases, Malignant Neoplasms, and Diseases of the Heart, per 100,000 Population, 1954-2008
- Prevalence of risk factors by SES measures Smoking was more common among those with only primary education than those with secondary and tertiary education, for both men and women. Smoking was also more common among those in the lowest income group. A higher proportion of men and women with only primary education reported eating less than the recommended amounts of fruits and vegetables than those with secondary or at least tertiary education. Respondents in the second highest income group reported the highest proportion not meeting the recommended daily fruit and vegetable consumption. The prevalence of obesity and central obesity increased with increasing income, especially among women.
- Prevalence of risk factors by SES measures Elevated blood pressure and cholesterol was more common among women with only primary education than those with tertiary education. For men, elevated cholesterol and fasting blood sugar were more common among those with tertiary education. The prevalence of hypertension, high cholesterol and diabetes was also higher among those in the highest income group than those in the lowest income group. Work-related physical activity was more prevalent among women with tertiary education, while for men it was higher among those with primary education. Highly active commuting was most prevalent among the lowest income group, for both men and women. The prevalence of high leisure time physical activity (LTPA) was higher among those in the highest income group.
- Association between risk factors and SES measures (adjusted analyses) Those with secondary and tertiary education were less likely to smoke than those with only primary education. Those with higher incomes (e.g. PhP >= 173,388 for men) were less likely to smoke. Men with secondary and tertiary education were less likely to consume less than five servings of fruit and vegetables per day. Men with secondary and tertiary education were more than twice as likely to become centrally obese than those with only primary education. Women with higher incomes were significantly more likely to become centrally obese than those in the lowest income quartile.
- Association between risk factors and SES measures (adjusted analyses) A significant association between high blood pressure and increasing income was noted for men. Men with tertiary education were twice as likely to be at increased risk of having high cholesterol than those with only primary education. Positive associations were also observed between elevated cholesterol and income levels for women. Men in the highest income group had significantly increased odds of having diabetes compared with those in the lowest income group.
- Association between risk factors and SES measures (adjusted analyses) Women in the highest income group were more likely to engage in high levels of leisure time physical activity (LTPA) than those in the lowest income group.
- In summary, this slide shows the global vision for development that includes work on NCDs. The bottom row lists the global policy documents, including the recent Sustainable Development Goals (SDGs). They all rely on the four components of national NCD responses, which will include efforts from healthy cities.