The World Health Assembly 66
World Health Editors Network
"Enter the Stadium – Democratize Knowledge – Bring it
Home"
Non-communicable Diseases -- Overview
Professor Kathryn Taubert
Chief Science Officer
World Heart Federation
Geneva
May 19, 2013

“Today, NCDs (mainly CV diseases, cancers, chronic respiratory diseases & diabetes) represent a leading threat to human health and development. These 4 diseases are the world’s biggest killers, causing an estimated
35 million deaths each year 60% of all deaths globally - with 80% in low- and middle- income countries.”
Dr Ala Alwan
Assistant Director-General
Noncommunicable Diseases
& Mental Health
World Health Organization
--circa 2010

Noncommunicable diseases:
63% (36 million) of the total deaths/year
Heart disease
(48% of all NCDs)
Total
57 M
Infectious diseases/ injuries:
HIV/AIDS
Tuberculosis
Malaria
Other
Infectious
Diseases
Cancer
Injuries
Diabetes
Other chronic diseases
(WHO, 2008 data)

Non-communicable diseases (NCDs) are leading cause of death in the world
20000000
18000000
16000000
14000000
12000000
10000000
8000000
6000000
4000000
2000000
0
Global deaths by cause, all ages, 2008
57 million total deaths/yr globally; 63% (36 million) are from NCDs
HIV/AIDS Tuberculosis Malaria Cardiovascular
Diseases
Cancers Chronic respiratory diseases
Diabetes
The blue bars represent communicable diseases
The gold bars represent
NCDs
Source : WHO 2008: Global Health Observatory Data Repository

Ban Ki-moon
Secretary-General
United Nations
 “
NCDs hit the poor and vulnerable particularly hard and drive them deeper into poverty“
 “More than 25% of those who succumb to NCDs are in the prime of their working lives, and the vast majority of these individuals are in developing countries."
 “Our collaboration is more than a public health necessity. Noncommunicable diseases are a threat to development."

In 2009, the World Heart Federation and its sister federations the International
Diabetes Federation and the Union for
International Cancer Control formed the
Non ‐ Communicable Disease (NCD)
Alliance, joined in early 2010 by the
International Union Against
Tuberculosis and Lung Disease, together currently representing a network of over 2,000 civil society organizations in more than 170 countries.

Changing the face of global health

In September 2011, the United Nations held a high level meeting in
New York on the prevention and control of non-communicable diseases
(NCDs): only the second of its kind on a health issue in history. World
Heart Federation together with its NCD Alliance disease partners in cancer, chronic respiratory diseases and diabetes were instrumental in securing this meeting.

In September 2011 a Political Declaration was signed by all member states and now represents the NCD Targets roadmap.

Subsequently in May 2012, the World Health Assembly adopted a global target of a 25% reduction in premature mortality from NCDs by
2025 .
Welcome to

Modified from Taubert
Nature Clin Pract CV Med,
2007
?
Tobacco
Hypertension
Dyslipidemia
Obesity
Physical inactivity
Diabetes
Poor nutrition

In 2008, 80% of all deaths (29 million) from NCDs occurred in low ‐ and middle ‐ income countries, and a higher proportion (48%) of the deaths in the latter countries are premature (under the age of 70) compared to high income countries (26%). According to WHO’s projections, the total annual number of deaths from noncommunicable diseases will increase to 55 million by 2030 , if “business as usual” continues.

A Burden particularly on the Developing World

Global NCD Action Plan 2013-2020
Final draft

Aligning with WHO targets

WHF (Cardiovascular) – IDF (Diabetes) – UICC
(Cancer) – "the Union" (Respiratory)-- working together with WHO and the UN to put a global focus on non-communicable diseases

PUBLIC
AWARENESS
PRESS
MEDIA
Working together for
WAR ON
CARDIOVASCULAR
DISEASE
PRIORITY
INTERNATIONAL
SUPPORT
POLICY
POLICY MAKERS
MEDICAL/
SCIENTIFIC
COMMUNITY
SCIENTIFIC EVIDENCE

Working with the
World Health Organization (WHO):
We are the only recognized cardiovascular disease NGO partner to the WHO.
Special consultative status is granted to NGOs which have a special competence in, and are concerned specifically with, only a few of the fields of activity covered by the
ECOSOC.

Membership: 200 organizations from more than 100 countries worldwide that combines the strength of cardiology societies and heart foundations.
Message: cardiovascular disease, which includes heart disease and stroke, is the number one killer worldwide causing
17.3 million deaths annually.
The majority of premature deaths can
be prevented through controlling risk factors such as unhealthy diets, physical inactivity and tobacco use.

Fig. 1: Results of hypothetical placebo-controlled trials of a new drug for acute myocardial infarction.
Barratt A et al. CMAJ 2004;171:353-358
©2004 by Canadian Medical Association

Figure.
Barratt A et al. CMAJ 2004;171:353-358
©2004 by Canadian Medical Association

An estimated 36 million deaths, or 63% of the 57 million deaths that occurred globally in 2008, were due to noncommunicable diseases, comprising mainly cardiovascular diseases (48% of noncommunicable diseases), cancers (21%), chronic respiratory diseases (12%) and diabetes (3.5%). These major noncommunicable diseases share four behavioural risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. In 2008, 80% of all deaths (29 million) from noncommunicable diseases occurred in low ‐ and middle ‐ income countries, and a higher proportion (48%) of the deaths in the latter countries are premature (under the age of 70) compared to high income countries (26%). According to WHO’s projections, the total annual number of deaths from noncommunicable diseases will increase to 55 million by 2030, if
“business as usual” continues.

Absolute risk reduction, also termed risk difference, is the difference between the absolute risk of an event in the intervention group and the absolute risk in the control group.
Relative risk, also known as risk ratio, is the risk of an event in the experimental group divided by that in the control group.
In a trial of 441 patients at risk of developing pressure ulcers, patients were randomised to receive a sheepskin mattress overlay (intervention group) or usual treatment (control group) during their hospital stay.
Absolute risk:
10%
17%
The absolute risk reduction can then be calculated by subtracting the proportion of patients with ulcers in the sheepskin group from that in the control group.
37/223 minus 21/218 = .07 (70%)
In the trial, 10% of patients in the sheepskin group developed ulcers compared to
17% in the control group. So the risk of getting ulcers with a sheepskin overlay was
0.58 of that in the control group.
21/218 divided by 37/223 = .58 Relative risk reduction – 1-.58 = 42%

Raising the priority of cardiovascular health on the global health agenda -- UN General
Assembly Resolution on NCDs
♥ UN Millennium Development Goals drive global development agenda
♥ The NCD Alliance mobilized civil society to campaign for a United
Nations (UN) Summit on NCDs
♥ In May 2010, the UN voted unanimously for passage of resolution titled "Prevention and control of non-communicable diseases" whereby the UN convenes a High Level Summit (attended by heads of state or their designee) &the Sec'y General prepares a
NYC. A political declaration/outcomes document was approved. Called for national NCD plans by 2013 with action items e.g., goals for elimination transfats, reduction in consumption of salt, sugar & saturated fats.

“These diseases are preventable. Up to 80% of heart disease, stroke, and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol.”
Dr Ala Alwan

Tobacco use
30%
Multidrug
Therapy
50%
Essential
Med/Tech
80%
Diabetes/
Obesity
0%
Physical inactivity
10%
25 by 25 Salt/ sodium intake
30%
Raised blood pressure
25%
Fat intake
15%
Alcohol
10%