global health promotion
sjsaaorabi
Chapt13Slides.pptxNon communicable Diseases Chapter 13
“When you are willing to make sacrifices for a great cause, you will never be alone.”
Chapter 13: Non Communicable disease (NCDs)
1
The Importance of Non communicable Disease
Growing importance worldwide.
Burden of non communicable diseases greater than burden of communicable diseases in low-, middle-, and high-income countries.
Cardiovascular disease, diabetes, cancer, and mental disorders are most important in low- and middle-income countries.
Often prevented at low cost, but expensive to treat.
Chronic disease…..the public health
Challenge of the 21st century
The burden of non-communicable diseases is greater than burden of communicable diseases in low-, middle-, and high-income countries. According to WHO estimation the burden of non-communicable disease will almost equal to burden of communicable diseases by 2020 in Sub-Saharan Africa. The burden of diseases that low and middle income countries face is cardiovascular disease, diabetes, cancer, and mental disorders. The risk factors for NCDs are closely related to life styles which mean it is within people’s control. These diseases are prevented at a very low cost while treating the diseases is very costly.
2
Key Definitions
Non communicable disease cannot be spread by an infectious agent, they last a long time and they are often disabling.
Include cancers, diabetes, endocrine disorders, neuropsychiatric disorders, and sense organ disorders.
NCDs are opposite of communicable diseases in many aspects. They do not spread by an infectious agent though they might be associated with one, they last for a long period of time, in some cases life long, and they can be very disabling meaning they might seriously impair people’s ability to engage in day to day life.
3
Proportion of global NCD deaths under the age of 70,by cause of death
Source: Global status report on non communicable diseases 2010, WHO
Of the 57 million global deaths in 2008, 36 million, or 63%, were due to NCDs, principally cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. As the impact of NCDs increases, and as populations age, annual NCD deaths are projected to continue to rise worldwide, and the greatest increase is expected to be seen in low- and middle-income regions. While popular belief presumes that NCDs affl ict mostly high-income populations, the evidence tells a very different story. Nearly 80% of NCD deaths occur in low-and middle-income countries and NCDs are the most frequent causes of death in most countries, except in Africa. Even in African nations, NCDs are rising rapidly and are projected to exceed communicable, maternal, perinatal, and nutritional diseases as the most common causes of death by 2030.
4
Let us know about some key terms that are used in non-communicable disease discussions. Additional terms include: Body Mass Index – body weight in kilograms divided by height in meters squared. Obesity- A BMI equal to or greater than 30. Overweight- A BMI equal to or greater than 25 but less than 30.
5
The Costs and Consequences of Non-communicable Diseases
Direct costs of treatment.
Indirect costs from lost productivity.
Low-income countries are simultaneously facing burden of communicable diseases and non-communicable diseases.
The economic cost of NCDs is substantial given the fact that the burden of these diseases are increasing. Cost include direct cost of treatment which occurs for a long period of time and indirect cost that are resulted from lost productivity and disability.
6
The Burden of Non communicable Diseases
Cardiovascular disease
Cause of about 25% of all deaths worldwide.
Leading cause of death in low- and middle-income countries in 2010.
Was responsible for 10.5% of deaths among all age groups and for sexes.
Ischemic heart disease was the second leading cause of death in these countries and responsible for about 10% of deaths.
Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Almost 25% of the deaths are attributed to CVDs. Not only in high income countries, CVD is affecting low income countries as well. Rates of CVD vary by region.
7
The Costs and Consequences of Cardiovascular Disease
Study found that men die 56% more at the same age of CVD than men in high-income countries and women die 86% more at the same age of CVD than women in high-income countries.
Estimated that the countries involved would lose $84 billion in economic production between 2006 and 2015 from CVD.
Mean age of Heart Failure Patients
Ghana: 42 years old
Minnesota: 77 years old
Sources:
Amoah and Kallen. Cardiology. 2000
Senni et al. Circulation.1998
The age of CVD occurrence vary disproportionately in low and middle income countries and high income countries. One study in Africa found that direct cost of treating CVDs were about 25% of healthcare cost which translates into 2-3% of GDP of that country. People in low income countries are affected by CVDs at much lower age than high income countries.
8
The Burden of Non communicable Diseases
Diabetes
382 million people worldwide suffer from diabetes.
11.4% of population in north American and the Caribbean have diabetes versus 5.1% in Africa.
Prevalence is rapidly increasing due to obesity.
Costly complications including blindness, kidney failure, amputation of lower extremities, stroke, and others.
1.3 million people died of diabetes in 2010.
200 million people worldwide suffer from diabetes. Prevalence of diabetes is rapidly increasing because of increasing obesity in high income countries and in the high income group of low and middle income countries. Diabetes has a number of complications that includes blindness, kidney failure, amputation of lower extremities, stroke and others. Almost 2/3rd of the people with diabetes face some form of disability than people without such condition. Which is why the DALYs lost from diabetes are far greater than the prevalence of disease. Diabetes was the 8th leading cause of DALYs in high income countries in 2010 and the 16th leading cause of LAMI countries.
9
The Costs and Consequences of Diabetes
Cost of treating diabetes varies between 2.5% and 15% of health expenditures in different countries.
In India, paying for diabetes care can cost low income households about 1/3 of their incomes.
Latin America and the Caribbean have highest expenditures, sub-Saharan Africa has the lowest.
Indirect costs are probably high because many people do not receive proper treatment.
Quick fact:
About 150 million people each year suffer
financial catastrophe and around 100 million are
pushed under the poverty line because of
payment for health care. More than 90% of these
people live in low income countries.
The cost of treating diabetes varies between 2.5% and 15% of health expenditures in different countries .In India, paying for diabetes care can cost low income households about 1/3 of their incomes .In Latin America and the Caribbean have highest expenditures, sub-Saharan Africa has the lowest. Indirect costs are probably high because many people do not receive proper treatment and therefor suffer from.
10
The Burden of Non communicable Diseases
Cancer
Most important worldwide are lung, colon, breast, prostate, liver, stomach, and cervix.
15 percent of all deaths for all age groups and both sexes in 2010.
In 2012 there were 14.1 million new cancer cases in 2012 and 8.2 million cancer-related deaths.
All forms of cancer made up 7.6 percent of all DALYs in 2010.
Tobacco use is the single largest preventable cause of cancer worldwide.
There are many different from of cancers worldwide. Among them the most important in terms of burden of disease are lung, colon, breast, prostate, liver, stomach, and cervix cancers. The risk factors for cancers vary a lot. In general, they are more likely to be associated with tobacco use, lifestyle factors and the presence of some infectious agents.
11
The Cost and Consequences of Cancer
Cancer causes the highest economic loss of all the 15 leading causes of death worldwide.
The total economic impact of premature death and disability from cancer was 1.5% of the world’s GDP in 2008.
Cancer causes the highest economic loss of all the 15 leading causes of death worldwide. The total economic impact of premature death and disability from cancer was 1.5% of the world’s GDP in 2008.
12
The Burden of Non communicable Diseases
Mental Disorders
Includes neurological disorders like epilepsy, drug and alcohol abuse, and mental disorders.
Responsible for 7.4% of DALYs lost in low- and middle-income countries.
Start at relatively young ages, go on for a long time, often cannot be cured, and produce large amounts of disability.
Unipolar depressive disorders are growing in importance.
Neurological disorders like epilepsy, drug and alcohol abuse, and mental disorders account for 7.4% of DALYs in low and middle income countries. Four mental illness share the largest burden of mental disorders and these are Unipolar depressive disorders or depression, schizophrenia, panic disorder and bipolar affective disorder. Depression is of growing important, as it’s the 2nd leading cause of DALYs.
13
This table lists definitions of the four major mental health disorders.
14
The Costs and Consequences of Mental Disorders
Little data from low- and middle-income countries indicative of unappreciated costs of mental illness
Mental and behavioral disorders are very important to the burden of disease, causing about 7.4% of all DALLYs in LAMI countries.
Four mental disorders contribute to the largest share: unipolar depressive disorders, such as depression, schizophrenia, anxiety disorders, and bipolar affective disorder.
Source: http://www.who.int/whr/2001/media_centre/press_release/en/
There are relatively little data from low- and middle-income countries indicative of unappreciated costs of mental illness. One in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide. Treatments are available, but nearly two-thirds of people with a known mental disorder never seek help from a health professional. Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders, says the World Health Organization (WHO). Where there is neglect, there is little or no understanding.
15
The Burden of Non communicable Diseases
Vision and Hearing Loss
Aging of populations globally and improved life expectancy increase importance.
Vision loss responsible for .8% of all DALYS globally.
Hearing loss responsible for .64% of DALYS globally.
Adult-onset hearing loss will be in the top 10 causes of the burden of disease worldwide, ranging from 2.6% in LAMI countries to 4% in high income countries.
Aging of populations globally improved life expectancy which in turn has increased the importance of vision and hearing loss as the cause of the disease burden. Vision loss is responsible for 3.3% of the burden of disease and hearing loss is responsible for 1.7% of the burden of disease. The major reasons for vision loss included refractive disorders, cataract, glaucoma, trachoma and onchocerciasis. For hearing, childhood onset hearing loss is related with congenital conditions, infections of the ear, or complications of other diseases. Adult onset hearing loss is related with exposure to noise and chemicals, as well as aging. It has been projected that hearing loss will be in top 10 causes of the burden of disease in 2030.
16
The Costs and Consequences of Hearing and Vision Loss
Very little data available.
Associated costs could include constraints to the education of children, school days missed by children with disabilities, cost of additional medical visits, high cost of education for students with hearing loss, difficulties for adults with finding employment, lower income levels.
Unfortunately, very little data available about the economic costs of vision and hearing loss specially in low and middle income countries. Associated costs could include constraints to the education of children, school days missed by children with disabilities, cost of additional medical visits, high cost of education for students with hearing loss, difficulties for adults with finding employment, lower income levels.
17
The Burden of Non communicable Disease
Tobacco Use
5 million deaths annually associated with tobacco use, half of those in low- and middle-income countries.
Most common tobacco-related deaths are CVD, diseases of the respiratory system, and cancer.
Rates of smoking vary by region and across regions according to sex, age, socioeconomic status, and other factors.
Usage increasing in men in low- and middle-income countries and women in all regions.
5 million deaths annually associated with tobacco use, half of those in low- and middle-income countries. The most common tobacco-related deaths are CVD, diseases of the respiratory system, and cancer. Rates of smoking vary by region and across regions according to sex, age, socioeconomic status, and other factors. The usage of tobacco is increasing in men in low- and middle-income countries and women in all regions.
18
The Costs and Consequences of Tobacco Use
Tobacco Use
Estimates from high-income economies suggest that costs of smoking range from 0.1% to 1.1% of GDP.
Economic costs are increasing in low- and middle-income countries.
Disproportionate impact on relatively poor people because they tend to smoke at higher rates.
Estimates from high-income economies suggest that costs of smoking range from 0.1% to 1.1% of GDP with higher economic cost in low- and middle-income countries. There is evidence that cigarette consumption has declined significantly in higher income countries. Tobacco use consequences has disproportionate impact on relatively poor people because they tend to smoke at higher rates.
19
The Burden of Non communicable Disease
Abuse of Alcohol
Responsible for .7% of DALYS globally.
Increases risk for hypertension, liver damage, heart disease, and other problems.
Intoxication associated with injuries and high-risk sexual encounters.
Prevalence of high-risk drinking varies by region with men in Europe and Central Asia having the highest rates.
Alcohol abuse is responsible for 4% of burden of disease and increases risk for hypertension, liver damage, heart disease, and other problems. Alcohol intoxication is associated with injuries and high-risk sexual encounters like accidents, injuries, first sexual encounter of teens, unprotected sex and intimate partner violence. The prevalence of high-risk drinking varies by region with men in Europe and Central Asia having the highest rates.
20
Addressing the Burden of Non-communicable Diseases
Tobacco Use
Taxing cigarettes at higher rates would be effective for reducing consumption.
Legal restrictions on smoking.
Ban on cigarette advertising.
Biggest impact in high-income settings has come from comprehensive control programs.
Abuse of Alcohol
Very few countries have made coherent efforts to reduce alcohol consumption.
Limiting hours when alcohol can be bought or sold and checking sobriety of drivers has showed some success.
Taxing can reduce consumption but could lead to smuggling and consumption of illicit alcohol.
Individual counseling shows some success, but would be difficult for countries with limited resources.
Evidence suggests that a number of steps can be taken to reduce the use of tobacco. Taxing cigarettes at higher rates would be effective for reducing consumption. Methods like legal restrictions on smoking and ban on cigarette advertising has shown to have achieved success. High income countries have had the biggest impact comprehensive control programs. In the area of alcohol abuse very few countries have made coherent efforts to reduce alcohol consumption. Some interventions like limiting hours when alcohol can be bought or sold and checking sobriety of drivers have showed some success. Intervention like taxing can reduce consumption but could lead to smuggling and consumption of illicit alcohol. Individual counseling shows some success, but would be difficult for countries with limited resources.
21
Addressing the Burden of Non communicable Disease
High Blood Pressure, High Cholesterol, and Obesity
Large-scale health education campaigns to promote healthier eating habits with greater intake of fruits and vegetables and less fat and salt.
Public policies and community layouts that promote physical activity.
Cancer
Tobacco control is first priority.
Addressing infectious agents associated with cancer like H.pylori and schistosomiasis.
The majority of the risk associated with cardiovascular disease relates to combination of high blood pressure, high cholesterol, high body mass index, low intake of fruits and vegetables, physical inactivity and tobacco and alcohol use. Large-scale health education campaigns to promote healthier eating habits with greater intake of fruits and vegetables and less fat and salt are very much needed to address the concerns. Public policies and community layouts that promote physical activity are essential to face the challenges of CVD. In controlling cancer, tobacco control is first priority as it relates to a number of diseases. In low and middle income countries, addressing infectious agents associated with cancer like Helicobacter pylori and schistosomiasis should be of high priority to cost effectively control cancer.
22
Addressing the Burden of Non communicable Disease
Mental Disorders
Little progress in low- and middle-income countries due to lack of understanding, low funds, and stigma.
Creating a mental health policy and budget is the first step.
Integrating mental health into community-based primary care and psychosocial supports instead of large, centralized hospitals has demonstrated success.
Oral Health
Dental caries are present in 90% of the global population
Interventions focused on cost-effective prevention methods that combine social policy and individual action will have the most impact.
Include oral health in comprehensive chronic disease programs.
Unfortunately, despite the growing importance of mental disorders, little progress has been made in low- and middle-income countries due to lack of understanding, low funds, and stigma associated with it. WHO recommends that in low and middle income countries creating a mental health policy and budget is the first step. In addition to that integrating mental health into community-based primary care, training primary health care in mental health, proper budgeting for mental health care are necessary to address the challenge. Oral health also needs to be addressed, since the majority of the population worldwide has dental caries. If left untreated, diseases can advance, infection can ensue and diseases can contribute to childhood morbidity and have a negative impact on their quality of life.
23
Future Challenges
Number of new cases of non communicable disease will grow because of aging, urbanization, globalization and lifestyle changes.
Number of people with disease will also rise because the diseases are chronic.
Low-income countries will have to deal with communicable and non communicable disease simultaneously, as well as with injuries.
The number of new cases of non-communicable disease will grow because of aging, urbanization, globalization and lifestyle changes. Number of people with disease will also rise because the diseases are chronic. Related to this low-income countries will have to deal with communicable and non-communicable disease simultaneously, as well as with injuries. Low income countries will need to incorporate prevention and control of NCDs in the primary care setting.
24
