NONCOMMUNICABLE DISEASES

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NONCOMMUNICABLE DISEASES
Elena A. Abumuslimova
Ph.D., Associates Professor
Department of Public Health and Health Care,
Northern-West State Medical University named after I.I. Mechnikov, Saint-Petersburg
 Noncommunicable diseases are the leading killer
today and are on the increase.
 Nearly 80% of these deaths occurred in low- and
middle-income countries.
2
 More than nine
million of all deaths
attributed to
noncommunicable
diseases (NCDs) occur
before the age of 60.
• Around the world, NCDs
affect women and men
almost equally.
Global status report on noncommunicable diseases
(April 2011 the World Health Organization (WHO) )
 NCDs are the leading cause of death in the world,
responsible for 63% of the 57 million deaths that
occurred in 2008.
 The majority of these deaths - 36 million - were
attributed to cardiovascular diseases and diabetes,
cancers and chronic respiratory diseases.
4
 NCDs are largely
preventable by means of
effective interventions that
tackle shared risk factors,
namely: tobacco use,
unhealthy diet, physical
inactivity and harmful use of
alcohol.
 NCDs are not only a health
problem but a
development challenge as
well.
Global status report on noncommunicable diseases
(April 2011 the World Health Organization (WHO) )
 The leading causes of NCD deaths in 2008 were:
cardiovascular diseases (17 million deaths, or 48% of
NCD deaths); cancers (7.6 million, or 21% of NCD
deaths); and respiratory diseases, including asthma
and chronic obstructive pulmonary disease (COPD),
(4.2 million). Diabetes caused an additional 1.3
million deaths.
 Behavioural risk factors, including tobacco use,
physical inactivity, and unhealthy diet, are
responsible for about 80% of coronary heart disease
and cerebrovascular disease.
6
Cardiovascular diseases
 Cardiovascular disease is caused by disorders of the
heart and blood vessels, and includes coronary heart
disease (heart attacks), cerebrovascular disease (stroke),
raised blood pressure (hypertension), peripheral artery
disease, rheumatic heart disease, congenital heart
disease and heart failure.
 Although heart attacks and strokes are major killers in
all parts of the world, 80% of premature deaths from
these causes could be avoided by controlling the main
risk factors: tobacco, unhealthy diet and physical
inactivity.
7
Cardiovascular diseases:
Facts and figures
 Cardiovascular disease (CVD) causes more than half of
all deaths across the European Region.
 80% of premature heart disease and stroke is
preventable.
8
Cardiovascular diseases:
Contributing factors
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9
A person’s genetic make-up
The foundations of adult health are laid in early life
Socioeconomic group
Mental health
Diet
Overweight and obesity
Inactivity
Tobacco
Alcohol
Diabetes
Globalization and urbanization
Cardiovascular diseases:
Prevention
 Focusing on a combination of risk factors for
cardiovascular disease
 Implementing medical screening for individuals at
risk
 Providing effective and affordable treatment to
those who require it
10
Cardiovascular diseases:
Prevention
 It has been predicted that mortality from coronary heart disease
(CHD) in the United Kingdom could be halved by small changes in
cardiovascular risk factors: a 1% decrease in cholesterol in the
population could lead to a 2–4% CHD mortality reduction; a 1%
reduction in smoking prevalence could lead to 2000 fewer CHD
deaths per year; and a 1% reduction in population diastolic blood
pressure could prevent around 1500 CHD deaths each year.
 80% of the reduction in CHD mortality in Finland during the
period of 1972–1992 has been explained by a decline in the major
risk factors. Similarly, in Ireland, almost half (48.1%) of the
reduction in CHD mortality rates during 1985–2000 among those
aged 25–84 years has been attributed to favorable trends in
population risk factors. In both countries, the greatest benefits
appear to have come from reductions in mean cholesterol
concentrations, smoking prevalence and blood pressure levels.
11
Cardiovascular diseases:
Treatment
 Effective measures are available for people at high
risk. For example, combination drug therapy (such
as aspirin, beta blocker, diuretic and statin) can lead
to a 75% reduction in myocardial infarction (heart
attack) among those at high risk of having one.
 But many such interventions are not being
implemented, and about half of coronary patients in
the world still require more intensive blood
pressure management.
12
Cancer
 Cancer is the uncontrolled growth and spread of
cells that arises from a change in one single cell. The
change may be started by external agents and
inherited genetic factors and can affect almost any
part of the body. The transformation from a normal
cell into a tumour cell is a multistage process where
growths often invade surrounding tissue and can
metastasize to distant sites.
13
Cancer: Interaction between a person’s genetic
factors and any of three categories of external
agents
 physical carcinogens, such as ultraviolet and ionizing
radiation or asbestos;
 chemical carcinogens, such as vinyl chloride, or
betnapthylamine (both rated by the International
Agency for Research into Cancer as carcinogenic),
components of tobacco smoke, aflatoxin (a food
contaminant) and arsenic (a drinking-water
contaminant); and
 biological carcinogens, such as infections from certain
viruses, bacteria or parasites.
Most chemicals to which people are exposed in everyday life have not been
tested for their long-term impact on human health.
14
Cancer:
the majority of cancer deaths
 Lung, breast, colorectal, stomach and liver cancers
 In high-income countries, the leading causes of
cancer deaths are lung cancer among men and
breast cancer among women.
 In low- and middle-income countries cancer levels
vary according to the prevailing underlying risks.
In sub-Saharan Africa, for example, cervical cancer
is the leading cause of cancer death among women.
15
Cancer:
risk factors for cancer
tobacco use
unhealthy diet
insufficient physical activity
the harmful use of alcohol
Infections (hepatitis B, hepatitis C (liver cancer), human
papillomavirus (HPV; cervical cancer), Helicobacter
pylori (stomach cancer)
 Radiation
 variety of environmental and occupational exposures of
varying importance
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16
Cancer:
policy
WHO’s approach to cancer has four pillars:
 prevention,
 early detection,
 screening,
 treatment
 palliative care.
17
Cancer:
policy
 At least one third of the 10 million new cases of
cancer each year are preventable through reducing
tobacco and alcohol use, moderating diet and
immunizing against viral hepatitis B.
 Early detection and prompt treatment where
resources allow can reduce incidence by a further
one third.
 Effective techniques are sufficiently well established
to permit comprehensive palliative care for the
remaining more advanced cases.
18
Cancer:
national cancer control programme
 WHO has consolidated tools for countries in a
framework known as the national cancer control
programme, which focuses government attention and
services on all facets of the fight.
 A national cancer control programme is a public health
programme designed to reduce cancer incidence and
mortality and improve cancer patients’ quality of life,
through the systematic and equitable implementation of
evidence-based strategies for prevention, early
detection, diagnosis, treatment and palliation, making
the best use of available resources.
19
Chronic respiratory diseases:
Quick facts and figures
 According to the WHO Global Status Report on NCDs
2010, smoking is estimated to cause about 71% of all lung
cancer deaths and 42% of chronic respiratory disease
worldwide. Of the six WHO regions, the highest overall
prevalence for smoking in 2008 was estimated to be the
in the European Region, at nearly 29%.
20
Chronic respiratory diseases:
Quick facts and figures
 Survey data from 2002–2007 indicate that over half of all
children aged 13–15 years in many countries in the
European Region are exposed to second-hand tobacco
smoke at home. Second-hand smoke causes severe
respiratory health problems in children, such as asthma
and reduced lung function; and asthma is now the most
common chronic disease among children throughout
the Region.
21
Chronic respiratory diseases:
Quick facts and figures
 According to the latest available data for 1997–2006, over
12% of infant deaths in the world are due to respiratory
diseases.
 Indoor air pollution from biological agents related to
damp and mould increases the risk of respiratory
disease in children and adults. Children are particularly
susceptible to the health effects of damp, which include
respiratory disorders such as irritation of the
respiratory tract, allergies and exacerbation of asthma.
Damp is often associated with poor housing and social
conditions, poor indoor air quality and inadequate
housing hygiene.
22
Chronic respiratory diseases:
Quick facts and figures
 Increasing evidence suggests that allergic sensitization,
which is the most common precursor to the
development of asthma, can already occur antenatally.
Emphasis on the health, nutrition and environment of
the pregnant woman and the unborn child are therefore
essential.
 Ozone pollution causes breathing difficulties, triggers
asthma symptoms, causes lung and heart diseases, and is
associated with about 21 000 premature deaths per year
in 25 countries in the WHO European Region.
23
Chronic respiratory diseases:
Quick facts and figures
 Most countries in the world and the European Region
have introduced a wide range of comprehensive policies
to reduce and eliminate tobacco smoke. For example,
the advertising of cigarettes and the sale of tobacco
products to minors have been banned in more than 80%
of the countries in the Region. Smoking in restaurants
and bars continues to be regulated less strictly, however.
Ireland, Turkey and the United Kingdom are the first
countries to make public places 100% smoke free.
24
Diabetes
 Diabetes is a chronic disease that occurs when the
pancreas does not produce enough insulin (a
hormone that regulates blood sugar) or
alternatively, when the body cannot effectively use
the insulin it produces. The overall risk of dying
among people with diabetes is at least double the
risk of their peers without diabetes.
25
Diabetes: Quick facts and figures
 About 347 million
people worldwide
have diabetes.
 There is an emerging
global epidemic of
diabetes that can be
traced back to rapid
increases in overweight,
obesity and physical
inactivity.
26
Diabetes: Quick facts and figures
 Diabetes is predicted
to become the seventh
leading cause of death
in the world by the
year 2030.
 Total deaths from
diabetes are projected
to rise by more than 50%
in the next 10 years.
27
Diabetes: Quick facts and figures
 80% of diabetes deaths
occur in low- and
middle-income
countries.
 In developed countries
most people with
diabetes are above the
age of retirement,
whereas in developing
countries those most
frequently affected are
aged between 35 and 64.
28
Diabetes: Health implications
Elevated blood sugar is a common effect of uncontrolled
diabetes, and over time can damage the heart, blood
vessels, eyes, kidneys, and nerves.
Some health complications from diabetes include:
 Diabetic retinopathy
 Diabetic neuropathy
 Diabetes is among the leading causes of kidney failure;
10-20% of people with diabetes die of kidney failure.
 Diabetes increases the risk of heart disease and stroke;
50% of people with diabetes die of cardiovascular
disease (primarily heart disease and stroke).
29
Diabetes: Prevention
Without urgent action, diabetes-related deaths will increase
by more than 50% in the next 10 years. To help prevent type
2 diabetes and its complications, people should:
 Achieve and maintain healthy body weight.
 Be physically active - at least 30 minutes of regular,
moderate-intensity activity on most days.
 Early diagnosis can be accomplished through relatively
inexpensive blood testing.
 Treatment of diabetes involves lowering blood sugar and the
levels of other known risk factors that damage blood vessels.
 Tobacco cessation is also important to avoid complications.
30
Diabetes: Control
 People with type 1 diabetes require insulin; people with
type 2 diabetes can be treated with oral medication, but
may also require insulin.
 Blood pressure control
 Foot care
Other cost saving interventions include:
 Screening and treatment for retinopathy (which causes
blindness);
 Blood lipid control (to regulate cholesterol levels);
 Screening for early signs of diabetes-related kidney disease
and treatment.
These measures should be supported by a healthy diet,
regular physical activity, maintaining a normal body weight
and avoiding tobacco use.
31
Obesity
 Obesity is one of the greatest public health challenges of
the 21st century. Its prevalence has tripled in many
countries of the WHO European Region since the 1980s,
and the numbers of those affected continue to rise at an
alarming rate, particularly among children.
 In addition to causing various physical disabilities and
psychological problems, excess weight drastically
increases a person’s risk of developing a number of
noncommunicable diseases (NCDs), including
cardiovascular disease, cancer and diabetes.
 The risk of developing more than one of these diseases
(co-morbidity) also increases with increasing body
weight.
32
Obesity
 Overweight and obesity
are defined as "abnormal
or excessive fat
accumulation that may
impair health“
 Body mass index (BMI) – the
weight in kilograms divided by
the square of the height in
meters (kg/m2) – is a commonly
used index to classify
overweight and obesity in
adults. WHO defines overweight
as a BMI equal to or more than
25, and obesity as a BMI equal
to or more than 30.
33
Obesity: Quick facts and figures
 More than 1.4 billion adults
were overweight in 2008, and
more than half a billion
obese
 In 2008, more than 1.4 billion
adults were overweight and
more than half a billion were
obese. At least 2.8 million
people each year die as a result
of being overweight or obese.
The prevalence of obesity has
nearly doubled between 1980
and 2008. Once associated with
high-income countries, obesity
is now also prevalent in lowand middle-income countries.
34
Obesity: Quick facts and figures
 Globally, over 40 million
preschool children were
overweight in 2008
 Childhood obesity is one of the
most serious public health
challenges of the 21st century.
Overweight children are likely
to become obese adults. They
are more likely than nonoverweight children to develop
diabetes and cardiovascular
diseases at a younger age, which
in turn are associated with a
higher chance of premature
death and disability.
35
Obesity: Quick facts and figures
 Overweight and obesity are
linked to more deaths
worldwide than underweight
 65% of the world's population
live in a country where
overweight and obesity kills
more people than underweight.
This includes all high-income
and middle-income countries.
Globally, 44% of diabetes, 23% of
ischaemic heart disease and 7–
41% of certain cancers are
attributable to overweight and
obesity.
36
Obesity: Quick facts and figures
 Supportive environments and
communities are fundamental
in shaping people’s choices and
preventing obesity
 Individual responsibility can
only have its full effect where
people have access to a healthy
lifestyle, and are supported to
make healthy choices.
 WHO mobilizes the range of
stakeholders who have vital
roles to play in shaping healthy
environments and making
healthier diet options
affordable and easily accessible.
37
Obesity: Quick facts and figures
 The global obesity epidemic
requires a population-based
multisectoral, multidisciplinary, and culturally
relevant approach
 WHO's Action Plan for the
Global Strategy for the
Prevention and Control of
Noncommunicable Diseases
provides a roadmap to establish
and strengthen initiatives for
the surveillance, prevention and
management of
noncommunicable diseases,
including obesity.
38
Noncommunicable diseases:
country income
 About 30% of people dying from NCDs in low- and
middle-income countries are aged under 60 years
and are in their most productive period of life.
 The prevalence of NCDs is rising rapidly and is
projected to cause almost three-quarters as many
deaths as communicable, maternal, perinatal, and
nutritional diseases by 2020, and to exceed them as
the most common causes of death by 2030.
 In most middle- and high-income countries NCDs
were responsible for more deaths than all other
causes of death combined, with almost all highincome countries reporting the proportion of NCD
deaths to total deaths to be more than 70%.
39
Noncommunicable diseases:
Current status and trends in risk factors
 Common, preventable risk factors underlie most NCDs.
These risk factors are a leading cause of the death and
disability burden in nearly all countries, regardless of
economic development.
 The leading risk factor globally for mortality is:
1. raised blood pressure (responsible for 13% of deaths
globally),
2. followed by tobacco use (9%),
3. raised blood glucose (6%),
4. physical inactivity (6%),
5. overweight and obesity (5%).
40
Noncommunicable diseases:
Current status and trends in risk factors
 The prevalence of these risk factors varied between country

1.
2.
3.

1.
2.
41
income groups, with the pattern of variation differing
between risk factors and with gender. High-, middle- and lowincome countries had differing risk profiles.
Several risk factors have the highest prevalence in highincome countries. These include:
physical inactivity among women,
total fat consumption,
raised total cholesterol.
Some risk factors have become more common in middleincome countries. These include:
tobacco use among men,
overweight and obesity.
Noncommunicable diseases:
parameters for estimation of behavioural and
metabolic risk factors
 current daily tobacco smoking: the percentage of the
population aged 15 or older who smoke tobacco on a daily
basis.
 physical inactivity: the percentage of the population aged
15 or older engaging in less than 30 minutes of moderate
activity per week or less than 20 minutes of vigorous
activity three times per week, or the equivalent.
 raised blood pressure: the percentage of the population
aged 25 or older having systolic blood pressure ≥ 140 mmHg
and/or diastolic blood pressure ≥90 mmHg or on
medication to lower blood pressure.
42
Noncommunicable diseases:
parameters for estimation of behavioural and
metabolic risk factors
 raised blood glucose: the percentage of the population aged
25 or older having a fasting plasma glucose value ≥ 7.0
mmol/L (126 mg/dl) or on medication for raised blood
glucose.
 overweight: the percentage of the population aged 20 or
older having a body mass index (BMI) ≥ 25 kg/m2.
 obesity: the percentage of the population aged 20 or older
having a body mass index (BMI) ≥30 kg/m2.
 raised cholesterol: the percentage of the population aged 25
or older having a total cholesterol value ≥ 5.0 mmol/L (190
mg/dl).
43
Noncommunicable diseases:
Prevention and Control of NCDs
 Millions of deaths can be prevented by stronger
implementation of measures that exist today.
 These include policies that promote government-wide
action against NCDs:
1. stronger anti-tobacco controls
2. promoting healthier diets,
3. physical activity,
4. reducing harmful use of alcohol;
5. along with improving people's access to essential health
care.
44
Noncommunicable diseases:
Prevention and Control of Noncommunicable
Diseases
 There is the 2008-2013 Action Plan for the
implementation of the WHO Global Strategy on the
Prevention and Control of Noncommunicable Diseases.
This Action Plan was endorsed by the 2008 World Health
Assembly.
 It provides countries a roadmap for taking action
against NCDs, including raising the priority of NCD
control, improving disease surveillance, enabling
governments to take comprehensive action against the
diseases, and protecting countries, particularly
developing, from the burden of the epidemic.
45
Noncommunicable diseases:
The six objectives of the 2008-2013 Action Plan are:
 To raise the priority accorded to noncommunicable
disease in development work at global and national
levels, and to integrate prevention and control of such
diseases into policies across all government departments
 To establish and strengthen national policies and plans
for the revention and control of noncommunicable
diseases
 To promote interventions to reduce the main shared
modifiable risk factors for noncommunicable diseases :
tobacco use, unhealthy diets, physical inactivity and
harmful use of alcohol
46
Noncommunicable diseases:
The six objectives of the 2008-2013 Action Plan are:
 To promote research for the prevention and control of
noncommunicable diseases
 To promote partnerships for the prevention and control
of noncommunicable diseases
 To monitor noncommunicable diseases and their
determinants
 Evaluate progress at the national, regional and global
levels
47
First global ministerial conference on healthy
lifestyles and noncommunicable disease control
28-29 April 2011, Moscow, the Russian Federation
The aim of the conference was to support Member States develop
and strengthen policies and programmes on healthy lifestyles
and NCD prevention.
The conference had three main goals:
 to highlight the magnitude and socio-economic impact of NCDs;
 to review international experience on NCD prevention and control;
 to provide evidence on the pressing need to strengthen global and
national initiatives to prevent NCDs as part of national health plans
and sustainable development frameworks
48
UN General Assembly’s commitment
to fight noncommunicable diseases
 UN General Assembly adopt of the political declaration
on the prevention and control of noncommunicable
diseases. For the first time, global leaders have reached
consensus in the General Assembly on concrete actions
to tackle these diseases.
 Governments agreed on the need for global targets to
monitor these diseases and their risk factors like
tobacco use, unhealthy diet, physical inactivity and the
harmful use of alcohol.
49
UN General Assembly’s commitment
to fight noncommunicable diseases
 Global leaders committed to greater efforts to prevent
and treat noncommunicable diseases and improve
health care including better access to vital medicines.
 Success will depend on the engagement of non-health
sectors such as finance, agriculture, transportation,
urban development, and trade.
 Governments will integrate policies to reduce
noncommunicable diseases into health planning
processes and national development agendas.
 The declaration is a clear signal that global leaders
acknowledge the devastating impact of
noncommunicable diseases worldwide and that they are
committed to reducing it. The next step is to act on
those commitments.
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