Integrated Prevention and Control for
Non-communicable Disease in China
Dr. Jixiang Ma,
National Center for Chronic and Non-communicable
Disease Control and Prevention (NCNCD)
China CDC
1
Situation Analysis
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NCD Prevention and Control System in China
Chinese Center for Disease Control and Prevention, PR. China
China CDC
NCNCD
Division of NCD Risk Factors Surveillance
Division of Obesity & Metabolic Diseases Control
and Prevention
Division of Vital Registry & Death Cause
Surveillance
Division of Oral Health
Division of Integrated NCD control and Prevention
Division of Injury Control & Prevention
Division of CVD Control and Prevention
Division of Elderly Health
Division of Cancer Control and Prevention
Division of Mental & Psychological Health
WHO Collaborating Center on Community-based
Integrated NCD Control & Prevention
Society of NCD Control & Prevention, Chinese Preventive
Medicine Association
Main working areas for NCNCD
• NCD Surveillance
• Integrated NCD control and Prevention
NCD Surveillance
Disease Surveillance Points system(DSPs)
NCD Risk Factor
Surveillance
Death Cause Registry
CVD Registry
Since 2004
Since 2002
to be initiate
Geographic Distribution of DSPs System
Urban(64)
Rural (97)
Development of NCDs and RF Surveillance
2012
Funded by central finance
2007
2004
•31 provinces，170
counties/districts
•50,000 participants，floating
population
2010
•31 provinces，162 surveillance
points
•100,000， resident population
•31 provinces，160 surveillance
points
•50,000 participants，resident
population
•31 provinces，79 surveillance
points
•30,000 participants，resident
population
Questionnaire based survey
•
Tobacco use, alcohol consumption
•
physical activity
•
diet
•
Control and treatment for NCDs
Physical measurements
•
Height
•
Weight
•
Hip circumference
•
Blood pressure
Lab tests
•
Fast Blood glucose
•
Lipid
•
insulin
•
HbA1c
Development of NCDs and RF Surveillance
2012
Funded by central finance
2007
2004
•31 provinces，170
counties/districts
•50,000 participants，floating
population
2010
•31 provinces，162 surveillance
points
•100,000， resident population
•31 provinces，160 surveillance
points
•50,000 participants，resident
population
•31 provinces，79 surveillance
points
•30,000 participants，resident
population
Questionnaire based survey
•
Tobacco use, alcohol consumption
•
physical activity
•
diet
•
Control and treatment for NCDs
Physical measurements
•
Height
•
Weight
•
Hip circumference
•
Blood pressure
Lab tests
•
Fast Blood glucose
•
Lipid
•
insulin
•
HbA1c
Facts about NCD in China
Communicable,
maternal,
neonatial, and
nutritional
disorders
6%
Injuries
9%
CVD
38%
Other NCDs
9%
Chronic
Respiratory
Diseases
12%
In total, NCDs accounted for 70.1 million
deaths (85%), 18.7% up from 1990*
Cancer
26%
Deaths from NCDs in China, 2010
*Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study
2010. Lancet. 2013. 381(9882): 1987-2015.
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Prevalence of NCD risk factors in adults aged>18 in 2010
80.9%
83.4%
52.8%
47.0%
17.4%
Current male smoker Salt intake above 5g/d Oil intake over 25g/d
Vegetable & Fruit
intake <400g/d
Source：2010 PRC BRFSS
Excessive
alcohol consumption
11.9%
Regular Physical exercise
Epidemic of Biological Risk Factors of NCDs
305 million
236 million
120 million
97 million
32.9 million
Overweight
Obesity
Hypertension
Source：2010 China Annual Cardiovascular Report（Hypertension）;
2010 PRC BRFSS （Overweight、Obesity、Raised cholesterol、Diabetes）.
Raised cholesterol
Diabetes
Trends of Salt Intake in adults
(g/d)
Salt
Soy Sauce
数据来源：1982、1992、2002年营养调查（称重法）；2010年中国慢病行为危险因素监测（食物频率法）
Sources: China National nutrition survey 1982, 1992, 2002; National BRFSS 2010
Prevalence of hypertension
患病率：%
23millon
50million
110milliono
180million
Prevalence of hypertension in Chinese adults from 2004-2010
The national behavior risk factor surveillance indicated 20.5% , 25.1% , 30.7% of
hypertension prevalence in adults aged 18-69 in 2004, 2007, 2010
健康危害—糖尿病患病率持续增长
Prevalence of Diabetes
%
2010
Prevalence of diabetes and prediabetes in adults aged 18-69 in 2010
JAMA. 2013;310(9):948-958. doi:10.1001/jama.2013.168118
Diabetes control in Chinese adults, 2010
Awareness of diabetes
Diabetes control in Chinese adults, 2010
Treatment rate of Diabetes
Diabetes control in Chinese adults, 2010
50
40
40.2
35.2
36.3
30.4
35.9 34.2
30
20
10
0
East
Middle
Urban
West
Rural
Control of Blood Glucose for diabetes
Trends of Oil intake in adults
克
Recommendation by
WHO
Trend of Smoking Rate in adults
（年）
Male
Female
Prevalence of smoking in adults 15-69
来源：杨功焕，胡鞍钢.《控烟与中国未来》
Urban
Rural
Prevalence of alcohol harmful using
%
Prevalence of inadequate vegetable and fruit intake in 2010
Prevalence of physical inactivity in Chinese adults, 2010
Continuous increasing of overweight and obesity in adults
Prevalence of overweight in Chinese adults
24.3%, 27.7%, 31.0% of adults aged 18-69 were overweight in 2004, 2007, 2010
%
Prevalence of obesity in Chinese adults
7.5% , 8.1% , 12.6% of adults aged 18-69 were obesity in 2004, 2007, 2010
%
2004、2007和2010年我国18-69岁居民肥胖率比较（%）
Major Activity and Program
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Opportunities: Health Care Reform for NCD Prevention and
Management
Affordable
treatment
Affordable
medicine
Convenient
service
Basic Health
Insurance
System
Essential
Primary
Health Care
System
Medicine
Free from
disease
Essential
Public Health
Services
Five Priorities of Health Care Reform (2009-2011)
Better
services
Public
Hospital
Reform
Pilots
NCD Management—Health Financing
Coverage of Basic Health Insurance System
31.3US$
3.1US$
Health insurance schemes coverage
Essential Medicine Policy
lowering down the price of
common essential drugs by 30
to 40 percent
NRCMS
Public Health Services Programs
Essential public health services programs: 3.9US$ per person
Priority public health services (NCDs）investment
780 000 US$
38.5 Million US$
Chinese Center for Disease Control and Prevention, PR. China
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National Plan for NCD Prevention and Treatment (2012-2015)
issued by 15 Ministries and Commissions.
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MOH
National development and Reform Commission
Ministry of Education
Ministry of Science & Technology
Ministry of industry and information technology
Ministry of Civil Affairs
Ministry of finance
Ministry of human resources and social security
Ministry of environmental protection
Ministry of Agriculture
Ministry of Commerce
The State Administration of Radio Film and Television
General Administration of Press and Publication
General Administration of sport
State Food and Drug Administration
Promoting regulation & laws for tobacco control at national level
Criteria for smoke-free medical and health institutions, was issued by MOH and Patriotic
Health Campaign Committee in March, 2008.
Ban on Smoking in Public Places becomes an important task of the 12th Five Year Plan
(March 2011).
The Public Place Hygiene Management Regulation Implementation Plan stipulate smoke
free in indoor public places (March 2011).
The Evaluation System of Civilized City stipulates smoking free environment is one of the
indicators of evaluating civilized city (February 2011). Smoke free environments becomes
one of the key indicators of the accreditation of civilized city.
Promoting regulation & laws for tobacco control at provincial level
Regulations on Areas of Public Place for Banning Smoking in Beijing Municipality was
took effect in 2008.
Regulation on Banning Smoking in Public Place was issued by Shanghai, Hangzhou,
Guangzhou in 2011.
Harbin passed the legislation named “Preventing Hazards of Secondhand Smoke” in
2011.
Tianjin passed the legislation named “Prohibiting Smoking in the Public Place” in
2011.
Under the way: Guangdong Province, Luoyang, Qingdao, Lanzhou, Jinan. Shenyang,
and Shenzhen
Shandong salt reduction & hypertension control program(2011-2015)
Shandong-Moh Action on Salt and Hypertension (SMASH)
• Initiated by MOH and Shandong Province Government
• Goal: by 2015, the average daily salt intake per person in Shandong reduced to 10
grams;
总体思路 Strategy
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Advocacy: leadership building; food industry and food catering
Health communication for salt and hypertension
Community-based behavior change communication
Setting-based intervention
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Schools
Healthcare setting
Supermarkets
Food catering
• Nutrition labeling to include sodium contents
• Evaluation: Population-based survey pre- and post-interventions
Shandong-Moh Action on Salt and Hypertension (SMASH)
Shandong provincial progress of salt reduction intervention
• Social mobilization and public health education campaign
– Issued 2.03 million copies of health education material, hold 190 thousand times health lectures
and mass media propaganda
• Restaurant salt reduction action
– 8308 restaurants have taken salt reduction measures
• Promotion of Food nutrition label of processed food
– 1783 enterprises has indicated the sodium content on packages
• Training of key populations (chefs, teachers,doctors)
• Healthy kitchen campaign
• Supermarket salt reduction action
Shandong-Moh Action on Salt and Hypertension
Shandong-Moh Action on Salt and Hypertension (SMASH)
Pilot sites salt reduction action
• Chose Fushan district in Yantai and Gaomi city in Weifang as pilot sites
– Launched the pilot salt reduction program officially by ministry of health, China CDC and local
government
– Distribute the intervention protocol by local government and define the multi-sector duties on salt
reduction
山东省居民膳食盐食用量偏高
Salt Intake: High
Percent
Distribution of Daily Salt Intake (g)
Grams
Average Daily Salt Intake (g)
Male
Female
Urban
Rural
Grams of Salt per Day
目标群体
Target
population
成人钠摄入来源
Source of Sodium (adult)
咸菜, 4.82% pickles
soy sauce
酱油, 10.24%
酱类, 1.29% sauces
味精, 0.94% MSG
醋, 0.34%vinegar 谷类, 11.21% cereal
蛋类, 2.04% egg
鱼虾类, 1.58% fish and shrimp
其他, 7.78%
others
畜肉类, 1.23% meat
其它, 2.93% others
salt
精盐, 63.38%
调味品占膳食钠总摄入量的81.0%，加工食品占膳食钠总摄入量的10.0%
图2 山东省18-69岁居民钠摄入量来源
81.0% sodium
from condiments, and 10% from processed food
Establishment of Non-communicable Disease Control and
Prevention Demonstrative Districts
• A national wide project launched in 2010 with financial support from central
government.
• Aiming to establish demonstrative districts/counties nationwide in 3-5 years, to
cover more than 10% of the counties nationwide by 2015
• Strategies include government leading, community involved, partnership
building, and comprehensive prevention.
140 counties/districts from
30 provinces by 2012
• Local government
takes the leadership
• Multi-sectors gets
involved
• Comprehensive
prevention-oriented
services, promote
healthy lifestyles
• Collect and
disseminate best
practices
Thanks for your attention!
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