Non-communicable Diseases
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NON-COMMUNICABLEDISEASES
Takeda Medical Publication ClubEric Feng, Medical Science LiaisonSincerely Presents
WHO: Global Status Report on Non-communicable Diseases
2
Non-communicable Diseases (NCDs)
DiabetesCardiovas
cular
Chronic Lung
Malnutrition Lower back
Pain
Down Syndrome
Cancer Cystic
Fibrosis
Chronic kidney
PHYSICAL INACTIVITY
TOBACCO USE UNHEALTHY DIETS
HARMFUL USE OF ALCOHOL
GENETIC DISORDERS
3
While global health resources are currently focused largely on infectious diseases, NCDs affect more people and are a “silent epidemic” in middle-income countries.
NCDs ARE THE LEADINGCAUSE OF DEATH GLOBALLY
NON-COMMUNICABLE DISEASES•Cardiovascular •Cancer •Chronic
Lung •Diabetes
63%
OF AllGLOBALDEATHS
ARE CAUSEDBY
80% OF DEATH OCCUR IN LOW AND MIDDLE-INCOME COUNTRIES
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GLOBAL NCDs FACTs
WHO INDICATES THAT NCDs DEATHs ARE PROJECTED TO INCREASE BY 15% GLOBALLY BETWEEN 2010 AND 2020 (TO 44 MILLION
DEATHs )
TOTAL DEATHS
70%People
≥ 60 years old
AGE CATEGORY
36,000,000
People
Each Year
80%
MAJOR CAUSES
Cardiovascular Cancer
Respiratory Diabetes
5
Probability of dying from NCDs
Deaths from NCDs, WHO
6
Recourse in Hand, High Income Countries
62% 31%
High Income Countries own 62% world area, but only has 31% population
7
Mortality: Total Deaths
Low Income Lower Middle Income
Upper Middle Income
High Income0%
10%
20%
30%
40%
50%
5.4%
33.9%
10.3%
13.9%
9.4%
14.9%
2.1%1.1%1.5%
5.1%1.4% 1.0%
NCDs Communicable diseases Injuries
Income was coded by World Bank Income Group.
TOTAL DEATHs NUMBER: 56,888,289 PERSONs
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Mortality: Major Causes of NCDs Deaths
CVD Cancer Respiratory Digestive NC Diabetes0%
10%
20%
30%
40%
50%
60%
48.0%
21.0%
11.7%6.1%
3.6% 3.5%
TOTAL NCDs DEATHs NUMBER: 36,121,872 PERSONs
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Mortality: China Data
Total CVD & DM Cancer Respiratory0
100
200
300
400
500
600
700
800
900
1,000
495
260
105 89
665
312
182
118
Female Male
Deaths per 100,000 (age-standardized estimate)
10
Mortality: Total NCDs Deaths
Low Income Lower Middle Income
Upper Middle Income
High Income0%
10%
20%
30%
40%
50%
60%
70%
80%
4.1%
24.5%
7.9% 11.1%4.4%
28.9%
8.2%10.8%
8.6%
53.4%
16.2%21.9%
Female Male Total
Income was coded by World Bank Income Group.
TOTAL NCDs DEATHs NUMBER: 36,121,872 PERSONs
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Mortality: Cardiovascular
Low Income Lower Middle Income
Upper Middle Income
High Income0%
10%
20%
30%
40%
50%
60%
70%
80%
4.2%
25.5%
9.9% 10.3%4.2%
27.8%
9.2% 8.8%8.5%
53.3%
19.1% 19.1%
Female Male Total
Income was coded by World Bank Income Group.
TOTAL CVs DEATHs NUMBER: 18,582,231 PERSONs
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Mortality: Cancers
Low Income Lower Middle Income
Upper Middle Income
High Income0%
10%
20%
30%
40%
50%
60%
70%
80%
3.3%
20.1%
6.8%
17.6%
2.9%
27.1%
8.2%14.1%
6.2%
47.3%
14.9%
31.7%
Female Male Total
Income was coded by World Bank Income Group.
TOTAL CANCERs DEATHs NUMBER: 7,583,251 PERSONs
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Mortality: Chronic Respiratory Diseases
Low Income Lower Middle Income
Upper Middle Income
High Income0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3.4%
32.0%
3.4%6.7%4.7%
39.3%
4.9% 5.7%8.1%
71.2%
8.2%12.5%
Female Male Total
Income was coded by World Bank Income Group.
TOTAL CRDs DEATHs NUMBER: 4,233,863 PERSONs
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Mortality: Diabetes
Low Income Lower Middle Income
Upper Middle Income
High Income0%
10%
20%
30%
40%
50%
60%
70%
80%
6.8%
26.5%
11.5%8.9%
5.2%
22.8%
8.3% 10.1%12.0%
49.3%
19.8% 18.9%
Female Male Total
Income was coded by World Bank Income Group.
TOTAL DIABETES DEATHs NUMBER: 1,255,584 PERSONs
Risk Factors
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Tobacco
PhysicalInactive
HarmfulAlcohol use
Unhealthy Diet
Raised Blood Pressure
Malnutrition
RaisedCholesterol
Infection
Overweight Obesity
16
Population-wide Interventions: Best Buys▀ Protecting people from tobacco and banning smoking in public places
▀ Warning about the dangers of tobacco use
▀ Enforcing bans on tobacco and alcohol advertising
▀ Raising taxes on tobacco and alcohol
▀ Restricting access to retailed alcohol
▀ Reduce salt intake and salt content of food
▀ Replacing trans-fat in food with polyunsaturated fat
▀ Promoting public awareness about diet and physical activity
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Tobacco Consumption
Europe Americas Africa West P SE Asia Eastern M CHINA LI LMI UMI HI0
2
4
6
8
10
12
14
11.5
7.5
5.2 5.1
2.01.0
5.6
3.8
5.2
8.59.0
TOTAL ADULT (15+ YEARS) PER CAPITA CONSUMPTION, 2008
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Tobacco Products Policies
• In 2010, Turkey became one of the 17 smoke-free countries in the world;
• Increased tobacco taxes by 77%, which led to a 62% price increase on cigarettes;
• Pictorial health warnings on tobacco packaging;
• A comprehensive ban on tobacco advertising;
• A comprehensive smoke-free law for all public and work places;
• Egypt increased taxes by 87% for cigarettes and 100% for loose
tobacco, lead to an increase of 44% in retail prices and a 21% reduction in cigarette consumption;
• Ukraine elevated taxes by 127%, leading to a 73% increase in retail prices between February 2009 and May 2010.
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Individual Health-care Interventions
▀ Ensure Early detection and using cost-effective and sustainable health-care interventions
▀ Counseling and multidrug therapy, including glycaemia control, and high risk of CVDs
▀ Screening for cervical cancer, once, at age 40
▀ Early case finding for breast cancer (50 – 70 years)
▀ Early detection of colorectal and oral cancer
▀ Treatment of persistent asthma
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Implementation of fiscal interventions to influence behaviour change, 2010
66%27%
7%
IMPLEMENTED, 127
NOT IMPLEMENTED, 53
NO DATA, 13
HIGH: ■■■■■■■■ 82.4%
LOW: ■■■■■■ 54.5%
LOWER MIDDLE:
■■■■■■ 58.5%
UPPER MIDDLE:
■■■■■■■ 66.7%
IMPLEMENTED DUE TO INCOME
21
Availability implementation of guidelines for the management of hypertension, 2010
26%
39%
4%
23%
5%2% FULLY
IMPLEMENTED, 51PARTIALLY IMPLEMENTED, 76NOT IMPLEMENTED, 8NOT AVAILABLE, 45NO DATA, 9
UNKNOWN, 4
HIGH: ■■■■ 39.2%
LOW: ■ 9.1%
LOWER MIDDLE:
■■ 18.9%
UPPER MIDDLE:
■■■■ 37.8%
HIGH: ■■■■■■■ 68.6%
LOW: ■■■■ 38.6%
LOWER MIDDLE:
■■■■■■■ 71.7%
UPPER MIDDLE:
■■■■■■■■ 82.2%
FULLY IMPLEMENTED
FULLY + PARTIALLY IMPLEMENTED
22
Availability implementation of guidelines for the management of Diabetes, 2010
30%
40%
4%
20%
5%2% FULLY
IMPLEMENTED, 58PARTIALLY IMPLEMENTED, 78NOT IMPLEMENTED, 7NOT AVAILABLE, 38NO DATA, 9
UNKNOWN, 3
HIGH: ■■■■■ 47.1%
LOW: ■ 11.4%
LOWER MIDDLE:
■■ 22.6%
UPPER MIDDLE:
■■■■ 37.8%
HIGH: ■■■■■■■ 78.4%
LOW: ■■■■ 43.2%
LOWER MIDDLE:
■■■■■■■ 77.4%
UPPER MIDDLE:
■■■■■■■■ 80.0%
FULLY IMPLEMENTED
FULLY + PARTIALLY IMPLEMENTED
23
Individual Interventions in Diabetes with Evidence of EfficacyInterventions with evidence
of efficacyBenefit
Lifestyle interventions for preventing type 2diabetes in people at high risk
Reduction of 35–58% in incidence
Metformin for preventing type 2 diabetes forpeople at high risk
Reduction of 25–31% in incidence
Glycaemic control in people with HbA1cgreater than 9%
Reduction of 30% in microvascular disease
per 1 percent drop in HbA1cBlood pressure control in people whosepressure is higher than 130/80mmHg
Reduction of 35% in CVDs per 10 mmHg drop inblood pressure
Annual eye examinationsReduction of 60 to 70% in serious
vision loss
Foot care in people with high risk of ulcers
Reduction of 50 to 60% in serious foot disease
Angiotensin converting enzyme inhibitor usein all people with diabetes
Reduction of 42% in nephropathy; 22% drop
in cardiovascular disease
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The world has a sound vision and a clear road map to address NCDs
2000
2010
2003
2004
2008
Global Strategy for the Prevention and Control of
NCDs
WHO Framework Convention on Tobacco
Control
Global Strategy on Diet, Physical Activity and
Health
Action Plan for the Global Strategy for Prevention
and Control NCDs
Global Strategy to Reduce the Harmful Use
of Alcohol
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