Albert Francis E. Domingo, MD, MSc Consultant, Noncommunicable Diseases and Health Promotion Unit 8 March 2016 Philippine Perspectives: Noncommunicable Diseases, Risk Factors and Health Inequalities
Apr 16, 2017
Albert Francis E. Domingo, MD, MScConsultant, Noncommunicable Diseases and Health Promotion Unit
8 March 2016
Philippine Perspectives:
Noncommunicable Diseases, Risk Factors
and Health Inequalities
Noncommunicable Diseases, Risk Factors and Health Inequalities2 |
Healthy population
Population at risk
Population with sickness
Sick that need hospitalization but have no access to hospital care
Sickand
Hospitalized
0-6 7-27 28-364
1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Forces of nature, war, and legal intervention Forces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
terventionForces of nature, war, and legal in-
tervention
Self-harm and interpersonal vio-lence; unintentional injuries;
transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuriesSelf-harm and interpersonal violence;
unintentional injuries; transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuriesSelf-harm and interpersonal violence;
unintentional injuries; transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuriesSelf-harm and interpersonal violence;
unintentional injuries; transport injuriesSelf-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Self-harm and interpersonal violence; unintentional injuries; transport injuries
Major NCDs: Diabetes, urogenital, blood, and
endocrine diseases; car-diovascular diseases; chronic respiratory dis-
eases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Major NCDs: Diabetes, urogenital, blood, and endocrine diseases; car-
diovascular diseases; chronic respira-tory diseases; neoplasms
Mental and substance use disorders
Mental and substance use disorders
Mental and substance use disorders
Mental and substance use disorders
Mental and substance use disorders
Mental and substance use disorders
Mental and substance use disorders
Mental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disorders
Mental and substance use disordersMental and substance use disorders
Mental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disordersMental and substance use disorders
Mental and substance use disorders
Other NCDs
Other NCDs
Other NCDs
Other NCDs
Other NCDs
Other NCDs
Other NCDsOther NCDsOther NCDsOther NCDsOther NCDs
Other NCDsOther NCDs
Other NCDsOther NCDsOther NCDsOther NCDsOther NCDsOther NCDs
Other NCDs
Nutritionaldeficiencies
Nutritional deficiencies
Nutritional deficienciesNutritional deficiencies
Nutritional deficiencies
Nutritional deficiencies
Nutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficiencies
Nutritional deficienciesNutritional deficiencies
Nutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficienciesNutritional deficiencies
Nutritional deficiencies
Maternal andneonatal disorders
Maternal and neonatal disorders
Maternal and neonatal disordersMaternal and neonatal disorders
Maternal and neonatal disorders
Maternal and neonatal disorders
Maternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disorders
Maternal and neonatal disordersMaternal and neonatal disorders
Maternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disordersMaternal and neonatal disorders
Maternal and neonatal disorders
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malariaNeglected tropical diseases and
malariaNeglected tropical diseases and
malariaNeglected tropical diseases and
malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malaria
Neglected tropical diseases and malariaNeglected tropical diseases and
malariaNeglected tropical diseases and
malaria
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TB
HIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TBHIV/AIDS and TB
HIV/AIDS and TB
Diarrhea, lower respiratory, and other common infectious dis-
eases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseasesDiarrhea, lower respiratory, and other
common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseases
Diarrhea, lower respiratory, and other common infectious diseasesDiarrhea, lower respiratory, and other
common infectious diseases
Causes of Death over the Life-Course in the Philippines(2013, both sexes)
Other communicable, maternal, neonatal, and nutritional diseases Neglected tropical diseases and malaria
Data from the Global Burden of Disease (2013) as published in The Lancetdays years
Noncommunicable Diseases, Risk Factors and Health Inequalities4 |
The NCD Causation Pathway
Underlying determinants• Globalization• Urbanization• Population ageing• Social determinants
Common risk factors•Tobacco use•Unhealthy diet•Physical inactivity•Harmful use of alcohol•Air pollution•Age & heredity (non-modifiable)
Intermediate risk factors• Raised blood sugar• Raised blood
pressure• Abnormal blood lipids• Overweight/obesity• Abnormal lung
function
Diseases• Cardiovascular
disease• Cancer• Diabetes• Chronic respiratory
disease
Adapted from WHO (2005) Preventing Chronic Disease: a Vital Investment.
Noncommunicable Diseases, Risk Factors and Health Inequalities5 |
Early life environmental exposurescan lead to later-life health problems
Maternal toxic exposuresoxidative stress
Lowbirth weight
Cardiovascular disease and Diabetes Alzheimer’s,
Dementia, Parkinson’s
Noncommunicable Diseases, Risk Factors and Health Inequalities6 |
Who is/are the patient(s)?What are the diagnostics and therapeutics?
Figure from: GBD 2013 Risk Factors Collaborators (2015)
Noncommunicable Diseases, Risk Factors and Health Inequalities7 |
• NCDs and their risk factors start in higher socioeconomic status (SES) and in urban areas
• Those of higher SES respond to prevention campaigns first
Noncommunicable Diseases, Risk Factors and Health Inequalities8 |
• Those of lower SES continue to experience increasing NCDs
• The double burden of disease (noncommunicable and communicable) will further deplete scarce resources
• Those of lower SES are at risk of receiving inadequate care
Noncommunicable Diseases, Risk Factors and Health Inequalities9 |
Epidemiological Transition
1954
'55
'56
'57
'58
'59
'60
'61
'62
'63
'64
'65
'66
'67
'68
'69
'70
'71
'72
'73
'74
'75
'76
'77
'78
'79
'80
'81
'82
'83
'84
'85
'86
'87
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
'00
'01
'02
'03
'04
'05
'06
'07
2008
0
100
200
300
400
500
600
0
10
20
30
40
50
60
70
80
90
100
110
Communicable Diseases Malignant Neoplasm Diseases of the Heart
Year
Dea
ths
per 1
00,0
00 p
opul
atio
n (c
omm
unic
able
dis
ease
s)D
eaths per 100,000 population (non-com
municable diseases)
Source: Philippine Health Statistics, various years
Noncommunicable Diseases, Risk Factors and Health Inequalities10 |
Philippine Data Source and Methods
2003 National Nutrition and Health Survey– National; stratified, three-stage random sampling; n=3,307– 97% response rate– 20-65 years of age; 52.2% men, 47.8% women
Analysis done by the Food and Nutrition Research Institute
Socioeconomic Status (SES) variables:– Education (primary, secondary, at least tertiary)– Annual household income
• Low: PhP <= 53,064; Medium: PhP 53,065-92,192• High: PhP 92,193-173,387; Very high: PhP >= 173,388
Noncommunicable Diseases, Risk Factors and Health Inequalities11 |
From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
Noncommunicable Diseases, Risk Factors and Health Inequalities14 |
From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
Noncommunicable Diseases, Risk Factors and Health Inequalities15 |
From WHO (2010) Noncommunicable disease risk factors and socioeconomic inequalities – what are the risks?
Noncommunicable Diseases, Risk Factors and Health Inequalities16 |
How to Respond
Enhance and improve early childhood development programs and education for all social groups
Remove barriers to secure employment
Tax tobacco and alcohol, regulate their production and sales, and restrict advertising and marketing
Reduce dietary salt intake by regulation, education, and mass media campaigns for the marginalized
Adapted from: Di Cesare (2013) Inequalities in non-communicable diseasesand effective responses. The Lancet.
Noncommunicable Diseases, Risk Factors and Health Inequalities17 |
How to Respond
Improve financial and physical access to healthier diets (fresh fruits and vegetables, healthy fats, whole grains, etc.)
Implement universal, financially and physically accessible, high-quality primary care to reduce risk factors; enhance early detection and treatment of NCDs
Remove financial barriers to health care, reduce physical and behavioural barriers to health care use, and improve the quality of care especially in disadvantaged communities
Adapted from: Di Cesare (2013) Inequalities in non-communicable diseasesand effective responses. The Lancet.
2025 milestone: 9 voluntary global NCD targets
By 2030, reduce by one third premature mortality from NCDs
2030 milestone: NCD-related targets in the SDGs
2018 milestone: Four time-bound commitments
WHO Global NCD Action Plan 2013-
2020
2011 UN Political
Declaration on NCDs
2014 UN Outcome Document on NCDs
Governance Risk factors Health systems Surveillance
Components of national NCD responses
WHO Regional
NCD Action Plans
Getting to 2030: Global vision
Sustainable Development
Goals
Noncommunicable Diseases, Risk Factors and Health Inequalities19 |
HEALTH AND THE ENVIRONMENTDivision of Noncommunicable Diseases and Health through the Lifecourse