Dr. Elvira Beracochea presented on taking public health action to stop chronic non-communicable diseases (CNCDs). Up to 80% of CNCD deaths can be prevented through improved care and public health programs. CNCDs account for 70% of global deaths and will kill 10 billion from tobacco by 2030. Objectives were to discuss global and local actions to stop CNCDs and choose one 2014 action. Interventions like those in North Karelia involving communities and integrating services into healthcare were effective locally. The Fagerstrom Test for Nicotine Dependence was presented to assess addiction levels and guide tobacco treatment. Challenges include lack of trained workforce, medicines, and surveillance systems. Advoc

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. Disclosure
• Dr. Elvira Beracochea has nothing to
disclose regarding chronic non
communicable diseases.

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. 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. Why Stop CNCDs?

6. Globally CNCDs are …
Preventable
Reversible
Curable

7. Etiology
Yet
Poorly
Understood….

8. Behavioral Risk Factors
1.
2.
3.
4.
5.
Smoking
Alcoholism
Poor nutrition
Physical inactivity
Mental illness and/or stress

9. The Unfinished Agenda
• Rheumatic Fever
• Barker hypothesis that propose that
exposure to poor nutrition in utero
increases CNCD

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. CARMEN
Conjunto de Acciones para la
Reducción Multifactorial de
Enfermedades No transmisibles
Concerted actions to reduce
multifactorial non- transmissible
or non-communicable diseases

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. 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. 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. 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. 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. 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. 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. 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. 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. 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