Time to Act

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Time to Act

• The Wold Heart Federation Advocacy Toolkit

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Content

• The background -a look at the current NCDs and
  CVD situation
• Behind CVD -the risk factors
• CVD and NCDs-a neglected development issue
• We can act -the World Heart Federations and the
  worlds global response

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The background A look at the current NCDs and
CVD situation

•  NCDs are ranked as the third most likely risk
  to come true and the fourth most severe in its
  impact for 2009 
• The World Economic Forum

4
Global Burden of Disease NCDs cause over 50 of
deaths worldwide
Source WHO Global Burden of Disease Report
Update 2004, Geneva 2008 Note NCDs CVD,
cancer, chronic respiratory, diabetes
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Global Burden of Disease NCDs responsible for
high rates of premature mortality (deaths per
1000 in adults between 15-59 years)
Source WHO Global Burden of Disease Report
Update 2004, Geneva 2008
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NCDs Leading cause of male deaths worldwide

• Projected main causes of death in males by WHO
  region, all ages, 2005

• WHO region

Age-standardized death rates per 100,000

• Source Preventing Chronic Diseases A Vital
  Investment, WHO, 2005

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NCDs Leading cause of female deaths worldwide

• Projected main causes of death in females by WHO
  region, all ages, 2005

• WHO region

Age-standardized death rates per 100,000
Source Preventing Chronic Diseases A Vital
Investment, WHO, 2005
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Among NCDs, CVD is leading cause of death
worldwide

• Estimated global deaths by cause, all ages, 2005

Source WHO 2005 Preventing Chronic Diseases
A Vital Investment
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Burden of CVDMen and women by region
Number of CVD deaths in millions
Source WHO Country Profiles, 2002, www.who.int
10
A higher of CVD deaths occur between 35 and 64
years of age in countries with developing
economies
Source A Race Against Time, The Earth
Institute, Colombia University, Stephen Leeder,
2004
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Disease burden of CVD and NCDs falls heavily on
those between the ages of 15 69 in low- and
middle-income countries (2005 figures)
DALY (Disability Adjusted Life Year) The sum of
years of potential life lost due to
prematuremortality and the years of productive
life lost due to disability.
Source Public Policy and the Challenge of
Chronic Noncommunicable Diseases, World Bank,
2007
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•  The NCDs epidemic threathens to overwhelm
  health systems 
• WHO, ECOSOC meeting 2009
•  The costs of NCDS create a poverty trap () The
  epidemic of NCDs slows economic growth 
• WHO, ECOSOC meeting 2009
• There is a  bitter irony in promoting health as
  a poverty reduction strategy at a time when the
  costs of health care themselves can be a cause of
  poverty 
• Her Royal Highness Princess Muna Al-Hussein,
  Ecosoc Meeting 2009

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NCDs macro-economic impactLost National Income
2006-2015 (cumulative) 2005 Lost national income from premature deaths due to heart disease, stroke and diabetes
Lost national income (billions) Lost national income (billions) Countries
49 3 Brazil
558 18 China
237 9 India
8 0.4 Nigeria
31 1 Pakistan
303 11 Russian Federation
3 0.1 Tanzania
WHO "Heart disease, stroke and diabetes alone
are estimated to reduce GDP between 1 to 5 per
year in developing countries experiencing rapid
economic growth"
Source WHO Chronic Disease Report, 2005
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•  In Oman, it is estimated that there will be a
  210 increase in the demand for health care by
  2025, and treatment for cardiovascular diseases
  alone will account for 21 of total health care
  expenditures 
• WHO, ECOSOC Meeting 2009
•  Conservatives estimates in Brazil, China,
  India, Mexico, and South Africa indicate that
  each year at leat 21 million years of future
  productive life are lost because of CVD 
• WHO, ECOSOC Meeting 2009

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CVD macro-economic impact

• CVD is expensive for the world. It costs the
  European Union US 219 billion (169 billion).
  The most updated data from USA shows that CVD
  costs nearly US 403 billion in direct and
  indirect costs
• By comparison, the estimated cost of all cancers
  is US 189 billion (146.19 billion) and HIV US
  28 billion (22.4 billion)
• The economic burden is no longer confined to the
  affluent, industrial world
• In developing countries CVD disproportionately
  affect the working-age adults from lower
  socio-economic groups
• In 1995, the costs of tobacco-related disease
  accounted for 1.5 of GDP in China, and
  obesity-related costs were equivalent to 1.1 of
  the GDP

Source WHO, Hu Mao, 2002 Leeder et. Al. 2004
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NCDs ProjectionsDeath trends (2006-2015)
2005 2005 2006-2015 (cumulative) 2006-2015 (cumulative) 2006-2015 (cumulative)
Geographical regions (WHO classification) Total deaths (millions) NCD deaths (millions) NCD deaths (millions) Trend Death from infectious disease Trend Death from NCD
Africa 10.8 2.5 28 6 27
Americas 6.2 4.8 53 -8 17
Eastern Mediterranean 4.3 2.2 25 -10 25
Europe 9.8 8.5 88 7 4
South-East Asia 14.7 8.0 89 -16 21
Western Pacific 12.4 9.7 105 1 20
Total 58.2 35.7 388 -3 17
(WHO Chronic Disease Report, 2005)
WHO projects that over the next 10 years, the
largest increase in deaths from cardiovascular
disease, cancer, respiratory disease and diabetes
will occur in developing countries.
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NCDs ProjectionsProjected Deaths in 2015 and
2030
Intentional injuries
Other unintentional
Road traffic accidents
Other NCD
Cancers
CVD
CVD
Mat//peri/nutritional
Other infectious
HIV, TB, malaria
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CVD Projections

• Contact WHO

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Behind CVD The risk factors

•  Multiple studies confirm the rise of NCDs and
  risk factors around the world. But the rise in
  risk factors is only partly explained by a change
  in personal behaviours. Personal behaviours are
  not only a personal choice. Much larger forces
  are at play here 
• WHO, ECOSOC Meeting, July 2009

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NCDs Risk factors4 Diseases, 4 Modifiable
Shared Risk Factors
Tobacco Use Unhealthy diets Physical Inactivity Harmful Use of Alcohol
Cardio-vascular
Diabetes
Cancer
Chronic Respiratory
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NCDs Risk factors impactTobacco Behaviours
associated with risk factors are costly
Monthly household expenditure of tobacco vs.
nutritious food among street children in Mumbai
(India)
200
186.1
173.9
180
160
137.4
140
119
109.8
120
100
Avg. Monthly Exp in INR
80
61.9
48.5
60
43.6
40
20
0
Bidi
Eggs
Milk
Fruits
Gutkha
Cigarettes
Paan with tobacco
Mutton/ Chicken/ Beef
Source Path Canada 2003
Items Consumed
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CVD Risk factors 6 of top 10 risk factors in
low- and middle- income countries lead to CVD
Risk factor for CVD
Source Global Burden of Disease and Risk
Factors, Lopez and others, Oxford University
Press, 2006
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CVD Risk factorsProjected progression of
hypertension
Number of adults living with hypertension in
millions
Source International Society of Hypertension
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CVD Risk factors Trends in Hypertension

• More than 20 million people have hypertension in
  Africa, with a prevalence ranging from 25 to 35
  in adults aged 25-64 years
• In China, 18.8 above 18 of the population
  suffers from high blood pressure
• In England, 32.1 of people above 16 suffer
  from high blood pressure, and 2 out of 3
  people above 65 suffer from it as well
• WHO Regional Office for Africa (WHO/AFRO), The
  Health of the People The African Regional Health
  Report (2006). WHO Geneva 2006
• WHO Global Infobase, 2002 data for China
• WHO Global Infobase, 2003 data for England
• NHS, Health Survey for England, 2005

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CVD Risk factorsTrends in Tobacco

• 20.4 of Australian women 26.2 of men above 18
  and smoke
• In France, 26.5 of women and 33.3 of men
  between 12 and 75 are current users of tobacco
• In Chile, 43.6 of males and 31.8 of females
  above 15 are current users of cigarettes
• In Indonesia, 63.5 of males are daily users of
  tobacco
• ,,, WHO Global InfoBase, countries
  surveys from various years

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CVD Risk factorsTobacco use on the rise in
developing countries
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•  When money is tight, the first thing that drop
  out of the diet are usually healthy foods, like
  fruits, vegetables, and lean sources of protein,
  which are nearly always more expensive.
• Processed foods () become the cheapest way to
  fill a hungry stomach. This is the type of diet
  linked to the rise of chronic diseases. 
• Dr. Margaret Chan, ECOSOC Meeting, July 2009

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CVD Risk factors Trends in Obesity

• Worldwide, 30 of women and 40 of men are now
  overweight and 27 of women and 24 of men are
  obese
• In China, 18.8 of women and 19.1 of men above
  18 are overweight or obese
• In South Africa, 56.2 of women 29.1 of men
  above 15 and are overweight or obese
• In the US, 31.1 of males and 33.2 of females
  above 20 are obese
• In 2007, an estimated 22 million children under
  the age of 5 years were overweight throughout the
  world
• More than 75 of overweight and obese children
  live in low- and middle-income countries
• Balkau B, et al. A Study of Waist
  Circumference, Cardiovascular Disease, and
  Diabetes Mellitus in 168 000 Primary Care
  Patients in 63 Countries. Circulation,
  20071161942-1951
• ,,, WHO Global InfoBase, countries
  surveys from various years
• WHO http//www.who.int/dietphysicalac
  tivity/childhood/en/

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CVD Risk factors Childhood obesity trends
around the world
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CVD Risk factorsProjected prevalence of
overweight and obese school children by region
today and in 2010
46.4
41.7
38.2
27.2
27.7
25.5
23.5
22.9
12
10.6
Source Wang Y, Lobstein T, Worldwide trends in
childhood overweight and obesity. International
Journal of Pediatric Obesity. 2006 111-25
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CVD and NCDsA neglected development issue

•  Non-communicable diseases are responsible for
  twice the number of deaths caused by infectious
  diseases yet receive only a tiny fraction of
  national and development heath funding 
• Cherie Blair, ECOSOC Meeting, July 2009
•  There does not seem to be a consensus among
  development agencies on the need to include
  non-communicable diseases () in global
  discussions on development 
• Dr.Ala Alwan, ECOSOC Meeting, July 2009
•  The greatest burden of preventable death and
  disability in both rich and poor countries is
  being caused by the very conditions that are
  receiving least Official Development Assistance 
• Her Royal Highness Princess Muna Al-Hussein,
  ECOSOC Meeting, July 2009

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NCDsDonors are not responding to requests for
technical assistance
Official Development Assistance for Health (2006,
in US Billions, total is US21 billion)
ODA Official Development Assistance provided
by 24 OECD/DAC donor countries, as well as the EC
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Worldwide, current investement in CVD and other
chronic diseases is outrageoulsy low

• The Global Fund for HIV/AIDS, TB and Malaria
  total pledges paid to date USD 11.8 billion
• Since 2000, the World Bank has so far made
  available nearly US 1.2 billion to fund HIV/AIDS
  programmes in Africa
• In 2006, the International Finance Facility for
  Immunization launched a bond that raised US 1
  billion
• Total contributions to GAVI for the year 2007
  amounted to US 786 million
• Half of the US 1.8 billion allocated to health
  programmes by USAID in 2003 were for HIV/AIDS and
  infectious diseases. Another 45 were for
  maternal health, child survival and population
  control.
• For the 2008-2009 biennum, the WHO will allocate
  almost US 900 million to communicable disease
  whereas the budget allocated to non-communicable
  disease barely reaches US 160 million.

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but progress is being made slowly

• Despite the apparent imbalance in the WHO budget,
  the funding for non-communicable disease for the
  2008-2009 biennium represents a 44 increase from
  the 2006-2007 budget
• It now represents 4 of WHO total budget (total
  budget is roughly US 3.3 billion)
• Tobacco control, one of CVD main risk factors, is
  getting more and more funds the Bloomberg
  initiative had an endowment of US 125 million,
  directed at low- and middle-income countries. US
  250 million have recently been added to this
  pledge
• The Bill and Melinda Gates Foundation is now
  getting involved in tobacco control, by pledging
  US 125 million
• The Alliance for a Healthier Generation (USA) has
  so far received US 28 million from the Robert
  Johnson Foundation for its Healthy Schools
  programme
• Ovations is contributing US 15 million to create
  centres to counter chronic disease in developing
  countries
• The UK Medical Research Council supports the OxHA
  Grand Challenges in Chronic Non-Communicable
  Disease with a 6 million grant
• In 2007, IDF received a multi-year grant of US
  10 million for it BRIDGES programme which
  provides grants to fund translational research
  projects in diabetes prevention

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•  We must make the prevention and control of
  non-communicable diseases and improvement of
  maternal health top priorities of the development
  agenda (). Both are begging for more attention 
• Dr. Margaret Chan, ECOSOC Meeting, July 2009
•  I want to highlight the glaring omission of
  non-communicable diseases in the MDGs (). This
  anomaly should be corrected 
• Dr. Leslie Ramsammy, ECOSOC Meeting, July 2009

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A neglected development issue CVD and NCDs are
not included in the United Nations Millennium
Development Goals

1. Eradicate poverty and hunger
2. Achieve primary universal education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development

Cardiovascular and other chronic diseases must
be included
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We can actThe worlds and the World Heart
Federations global response

•  We know the major steps that need to be taken
  to reverse this tidal wave of non-communicable
  diseases 
• Cherie Blair, ECOSOC Meeting, July 2009
•  Control of non-communicable disease (is a)
  fully ready and mature area for efficient
  interventions with a huge return 
• Margaret Chan, ECOSOC Meeting, July 2009

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NCDsThe Global Response example at the WHO
level
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NCDs Fighting risk factorsSelected
Multi-sectoral Approaches to Reduce Tobacco Use

• Increase tax rates for tobacco products
• Enact and enforce completely smoke-free
  environments
• Make tobacco cessation advice available as part
  of primary health care
• Require effective package warning labels
• Enact and enforce legislation to ban any form of
  direct and indirect tobacco advertising,
  promotion and sponsorship
• Obtain free media coverage of anti-tobacco
  activities
• Implement counter-tobacco advertising
• Strengthen tax administration to reduce illicit
  trade in tobacco products
• For more information please refer to the
  Framework Convention on Tobacco Control

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NCDs Fighting risk factorsSelected
Multi-sectoral Approaches to Reduce Unhealthy Diet

• Reduce trans fatty acids and salt
• Restrict availability of energy dense foods and
  high calorie non-alcoholic beverages
• Increase availability of healthier foods
  including fruits and vegetables
• Practice of responsible marketing to reduce
  impact of unhealthy foods to children
• Make healthy options available and affordable
• Provide simple, clear and consistent food labels
  that are consumer friendly
• Reshape industry to introduce new products with
  better nutritional value
• For more information please refer to the Global
  Strategy on Diet Physical Activity and Health

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CVD The World Heart Federations answer

• Together with its members, the WHF achieves its
  mission through
• Awareness Building
• Advocacy
• Demonstration Projects
• Sharing Science/Building Capacity

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CVD World Heart Federations Activities
Sharing Science
Applied Research
Advocacy
Awareness Building
World Heart Day Go Red for Women Children/Adolescents - Sesame Workshop - Youth leadership Framework Convention on Tobacco Control WHO Global Strategy on Diet, Physical Activity Health CVD in Millennium Development Goals Wellness in the workplace Healthy Active Youth programme RF/RHD secondary prevention project in South Pacific/Africa Plaza Sésamo Colombia/Youth advocacy China Bridging the Gap The Polypill Grenada Heart Project Scientific Meetings World Congress of Cardiology Bi-annual Continental Society Congresses Continuing Education Fellowships Journals Nature Clinical Practice CV Médicine CVD Prevention Control
Building capacity
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CVDWorking with members to fight the disease
195
165
WHFs membership in 2002 and today
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CVDWorking with members to fight the disease
WHFs membership by region in 2002 and today
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CVDWorking with members to fight the disease
Member National Societies
Algerian Society of Cardiology Argentine Society
of Cardiology The Cardiac Society of Australia
New Zealand Austrian Society of
Cardiology Bangladesh Cardiac Society Belarusian
Scientific Society of Cardiologists Belgian
Society of Cardiology Bolivian Society of
Cardiology Association of Cardiologists of Bosnia
Herzegovina Brazilian Society of
Cardiology Bulgarian Society of
Cardiology Canadian Cardiovascular
Society Chilean Society of Cardiology
Cardiovascular Surgery Chinese Society of
Cardiology Colombian Society of
Cardiology Croatian Cardiac Society Cuban Society
of Cardiology Cyprus Society of Cardiology
Czech Society of Cardiology Danish Society of
Cardiology Dominican Society of
Cardiology Ecuadorian Society of Cardiology
Egyptian Society of Cardiology Society of
Cardiology of El Salvador
Finnish Cardiac Society French Society of
Cardiology Georgian Association of
Cardiology German Cardiac Society Ghana Society
of Hypertension and Cardiology Hellenic
Cardiological Society Guatemala Association of
Cardiology Honduras Society of Cardiology Hong
Kong College of Cardiology Hungarian Society of
Cardiology Cardiological Society of India
Indonesian Heart Association Iranian Heart
Association Iraqi Cardio-Thoracic Society Irish
Cardiac Society Israel Heart Society Italian
Federation of Cardiology Japanese Circulation
Society Jordan Cardiac Society Association of
Cardiologists of Kazakhstan Kenya Cardiac
Society The Korean Society of Circulation Associat
ion of Doctors of Internal Medicine of Kyrgyz
Republic Latvian Society of Cardiology
Lebanese Society of Cardiology and Cardiac
Surgery Libyan Cardiac Society Lithuanian Society
of Cardiology Macau Association of
Cardiology Macedonia Society of
Cardiology National Heart Association of
Malaysia Mexican Society of Cardiology Moldavian
Society of Cardiology Moroccan Society of
Cardiology Cardiac Society of Myanmar Medical
Association Cardiac Society of Nepal The
Netherlands Society of Cardiology Nicaraguan
Society of Cardiology Nigerian Cardiac
Society Norwegian Society of Cardiology Pakistan
Cardiac Society Society of Cardiology of
Panama Paraguayan Society of Cardiology Peruvian
Society of Cardiology Philippine Heart
Association Polish Cardiac Society Portuguese
Society of Cardiology Puerto Rican Society of
Cardiology Romanian Society of Cardiology
Society of Cardiology of the Russian
Federation San Marino Society of Cardiology Saudi
Heart Association Society of Cardiology of Serbia
and Montenegro Singapore Cardiac Society Slovak
Society of Cardiology Slovenian Society of
Cardiology The South African Heart
Association Spanish Society of Cardiology Sri
Lanka Heart Association Swedish Society of
Cardiology Swiss Society of Cardiology Syrian
Cardiovascular Association Taiwan Society of
Cardiology The Heart Association of Thailand
Turkish Society of Cardiology Ukrainian Society
of Cardiology Emirates Cardiac Society British
Cardiovascular Society American College of
Cardiology Uruguayan Society of
Cardiology Venezuelan Society of
Cardiology Vietnam National Heart Association
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CVDWorking with members to fight the disease
Member National Heart Foundations
Argentine Heart Foundation National Heart
Foundation of Australia Austrian Heart
Foundation National Heart Foundation of
Bangladesh Heart Foundation of Barbados Belgian
Heart League Foundation of Health and Heart
(Bosnia and Herzegovina) Brazilian Heart
Foundation (FUNCOR) Heart And Stroke Foundation
of Canada Chilean Heart Foundation Un Coeur pour
la Vie (Congo Brazzaville) Cyprus Heart
Foundation Healthy Nutrition Forum (Czech
Republic) Danish Heart Foundation Dominican Heart
Foundation Ecuadorian Foundation of
Cardiology Estonian Heart Association Finnish
Heart Association Georgian Heart
Foundation German Heart Foundation Ghanaian Heart
Foundation Hellenic Heart Foundation
(Greece) Hong Kong Heart Foundation Hungarian
National Heart Foundation Icelandic Heart
Association
Seychelles Heart and Stroke Foundation Singapore
Heart Foundation Slovak League Heart to
Heart Slovenian Heart Foundation Heart and Stroke
Foundation South Africa Spanish Heart
Foundation Swedish Heart Lung Foundation Swiss
Heart Foundation Taiwan Heart Foundation The
Heart Foundation of Thailand Turkish Heart
Foundation British Heart Foundation American
Heart Association Venezuelan Heart Foundation
All India Heart Foundation Heart Foundation of
Indonesia Irish Heart Foundation Italian Heart
Foundation The Heart Foundation of Jamaica Japan
Heart Foundation Kenya Heart Foundation Kuwait
Heart Foundation Lithuanian Heart
Association Macau Heart Foundation The Heart
Foundation of Malaysia Mauritius Heart
Foundation Nepal Heart Foundation Netherlands
Heart Foundation The National Heart Foundation of
New Zealand Nigerian Heart Foundation Norwegian
Council On Cardiovascular Disease Pakistan Heart
Foundation Cardiological Foundation of
Panama National Heart Foundation of Papua New
Guinea Paraguayan Heart Foundation Heart
Foundation of the Philippines Portuguese Heart
Foundation Foundation for Cardiac Assistance
(Romania) Serbian Heart Foundation
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CVDLeveraging Partnerships
International Organizations
NGOs/Not for Profit Associations
Corporate Partners/Major Sponsors
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• Quote by WHF