KAUNAS UNIVERSITY OF MEDICINE

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KAUNAS UNIVERSITY OF MEDICINE FACULTY OF PUBLIC
HEALTH DEPARTMENT OF PREVENTIVE MEDICINE
INTERNATIONAL HEALTH NONCOMUNICABLE DISEASES
AS GLOBAL HEALTH PROBLEM
PROF. Vilius GRABAUSKAS
FROM BISPH TRAINING COURSE PUBLIC HEALTH SCIENCE
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LEARNING OBJECTIVES

• TO UNDERSTAND THE TRANSITION IN GLOBAL HEALTH
• TO UNDERSTAND THE CAUSES OF THE ABOVE
• TRANSITION
• TO UNDERSTAND WHOs POLICY AND STRATEGIES TO
  COMBAT THE EPIDEMICS OF NONCOMMUNICABLE DISEASES

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THE WORLD HEALTH IS IN TRANSITION
EPIDEMIOLOGICAL NCDS OVERRIDING
INFECTIOUS DISEASES
AND DOUBLE
BURDEN OF DISEASES IN MANY
DEVELOPING COUNTRIES LIFESTYLES
TOBACCO USE IS INCREASING DIETS ARE RAPIDLY
CHANGING PHYSICAL ACTIVITY REDUCES
ALCOHOL USE INCREASES, OBESITY,
DIABETES, HYPERTENSION ARE
INCREASING IN MOST PARTS OF THE
WORLD, WHILE UNDER-NUTRITION
REMAINS A SEVERE ISSUE DEMOGRAPHIC
POPULATION AGEING. GLOBALIZATION INCREASING
GLOBAL INFLUENCES
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THE GLOBAL NCD REALITY

• NONCOMMUNICABLE DISEASE CONTRIBUTE 60 OF DEATHS
  AND 43 OF THE GLOBAL BURDEN OF DISEASE. ALREADY
  79 OF THESE NCDS ARE OCCURRING IN DEVELOPING
  COUNTRIES.
• BY 2020 THESE DEATHS WILL ACCOUNT FOR 73 DEATHS
  AND 60 OF THE DISEASE BURDEN.
• HALF OF THESE DEATHS ARE ATTRIBUTABLE TO
  CARDIOVASCULAR DISEASES.
• THERE ARE MORE CVD DEATHS IN INDIA OR CHINA THAN
  IN ALL DEVELOPED COUNTRIES ADDED TOGETHER.

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WORLD, DEATHS, BY BROAD CAUSE GROUP, 2001
Total deaths 56,554,000
Noncommunicable conditions (33.1 million)
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies (18.4
million)
Injuries (5.1 million)
Source WHR 2002
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WORLD, DALYs, BY BROAD CAUSE GROUP, 2001
Noncommunicable conditions
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies
Injuries
Source WHR 2002
Vilius GRABAUSKAS
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DEATHS, BY BROAD CAUSE GROUP AND WHO REGION, 2001
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies
Noncommunicable conditions
Injuries
75
50
25
AFR
AMR
EMR
EUR
SEAR
WPR
Source WHR 2002
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DALYs, BY BROAD CAUSE GROUP AND WHO REGION, 2001
Noncommunicable conditions
Communicable diseases, maternal and perinatal
conditions and nutritional deficiencies
Injuries
75
50
25
AFR
AMR
EMR
EUR
SEAR
WPR
Source WHR 2002
Vilius GRABAUSKAS
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WORLD, DISTRIBUTION OF CAUSES OF DEATH, 2001
Total deaths 56,554,000
Other NCDs
Respiratory infections
Respiratory diseases
Neuropsychiatric disorders
HIV/AIDS
Digestive diseases
Perinatal conditions
Malignant neoplasms
Diarrhoeal diseases
Tuberculosis
Childhood diseases
Diabetes
Malaria
Maternal conditions
Nutritional deficiencies
Other CD causes
Cardiovascular diseases
Injuries
Source WHR 2002
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WORLD DISEASE BURDEN (DALYs), 2001
Maternal conditions
Perinatal conditions
Nutritional deficiencies
Respiratory infections
Other NCDs
Malaria
Malignant neoplasms
Childhood diseases
Diabetes
Diarrhoeal diseases
Neuropsychiatric disorders
HIV/AIDS
Tuberculosis
Other CD causes
Sense organ disorders
Cardiovascular diseases
Injuries
Respiratory diseases
Congenital abnormalities
Digestive diseases
Musculoskeletal diseases
Diseases of the genitourinary system
Source WHR 2002
Vilius GRABAUSKAS
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NCDs ARE TO A GREAT EXTEND PREVENTABLE

• KEY RISK FACTORS UNHEALTHY DIET (SALTY, FATTY
  AND SUGARY FOOD), PHYSICAL INACTIVITY, TOBACCO
  AND ALCOHOL DRINKING.
• THE BEHAVIOURAL FACTORS LEAD TO HIGH BLOOD
  PRESSURE HYPERTENSION, BLOOD GLUCOSE
  INTOLERANCE DIABETES, ELEVATED BLOOD
  CHOLESTEROL HYPERCHOLESTEROL, ANAEMIA,
  OVERWEIGHT AND OBESITY.
• SIMPLE CHANGES IN THESE LIFESTYLES CAN
  POWERFULLY PREVENT CHRONIC DISEASES AND PROMOTE
  HEALTH.
• SOME OF THE CHANGES TAKE PLACE RELATIVELY QUICKLY
  AND ALSO IN LATE AGE.

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WHAT PREVENTS EFFECTIVE NCD ACTION?

• MYTHS ABOUT NCDs diseases of affluence, of
  ageing, of men
• UNDERESTIMATION OF PREVENTION IMPACT
• MYTH OF CONG DELAY IN PRENTION EFFECT
• LOW PUBLIC VISIBILITY (Perceived threat)
• LACK OF DIRECT ECONOMIC INTERESTS (vs drugs or
  clinical measures)
• CONFLICTING MESSAGES, often related to commercial
  interests
• INERTIA IN CHANCE administration, financing,
  services etc

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WHO RESPONSE

• EVIDENCE BASE, ADVOCACY, SURVEILLANCE, TRAINING
• NATIONAL PROGRAMMES AND POLICIES
• REGIONAL ACTIVITIES WHO REGIONAL OFFICES AND
  REGIONAL NETWORKS
• GLOBAL ACTION PARTNERSHIP, ATTENTION TO GLOBAL
  ASPECTS (MARKETING, TRADE, COMMUNICATION ETC)
• SURVEILLANCE AND MONITORING

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WHO RESPONSE

• WHOS GLOBAL STRATEGY FOR NCD PREVENTION
• AND CONTROL (WORLD HEALTH ASSEMBLY 2000)

• NCDS A PRIORITY
• PREVENTION KEY
• INTEGRATED PREVENTION
• TARGETS MAIN COMMON RISK FACTORS
• - TOBACCO
• - UNHEALTHY DIET
• - PHYSICAL INACTIVITY

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HEALTHY LIFESTYLES

• FOR INDIVIDUAL
• EFFECTIVE WAY TO
• PREVENT DISEASES AND PROMOTE HEALTH
• FOR THE SOCIETY
• A COST EFFECTIVE AND SUSTAINABLE WAY
• TO IMPROVE PUBLIC HEALTH

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STRATEGIES TO REDUCE RISKWORLD HEALTH REPORT
2002 MESSAGES

• VERY SUBSTANTIAL HEALTH GAINS CAN BE MADE FOR
  RELATIVELY MODEST EXPENDITURES ON INTERVENTIONS
• CHANGING POPULATION DISTRIBUTIONS OF RISK FACTORS
  (LIKE BLOOD PRESSURE, BLOOD CHOLESTEROL) THROUGH
  GENERAL LIFESTYLE CHANGES
• CVD POPULATION WIDE STRATEGIES TO LOWER
  CHOLESTEROL (QUALITY OF FAT) AND BLOOD PRESSURE
  (SALT REDUCTION) KEY
• TOBACCO HIGHER TAXES, COMPREHENSIVE
  ADVERTISEMENT BAN
• MIX OF POPULATION WIDE, HIGH RISK AND SECONDARY
  PREVENTION MEASURES, IN A COST EFFECTIVE BALANCE
• SUSTAINED POLICY ACTION
• STRENGTHENING OF NATIONAL INSTITUTIONS TO
  IMPLEMENT AND EVALUATE RISK REDUCTION PROGRAMMES

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NCD PREVENTION AND HEALTH PROMOTION
NETWORKS GLOBAL INTEGRATED NCD PREVENTION
NETWORKS CINDI EUROPEAN NETWORK IN 27
COUNTRIES CARMEN LATIN AMERICAN NETWORK IN 8

COUNTRIES INITIATIVE IN EASTERN EMAN
MEDITERRANEAN REGION NANDI
INITIATIVE IN THE AFRICAN
REGION (SEARO) SOUTH EAST REGION PLANS ARE
UNDER
WAY (WPRO) WESTERN PACIFIC REGION PLANS ARE
UNDER
WAY MEGA COUNTRY HEALTH PROMOTION NETWORK 11
COUNTRIES OVER 100 MIL. PEOPLE
Vilius GRABAUSKAS