chronic diseases worldwide
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Giovanni Viegi CNR Institute of Clinical Physiology, Pisa, Italy 2006-07 ERS Past President on behalf of Nikolai Khaltaev, MD, PhD Chronic Diseases and Health Promotion, WHO, Geneva (CH). - PowerPoint PPT PresentationTRANSCRIPT
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Giovanni ViegiCNR Institute of Clinical Physiology, Pisa, Italy
2006-07 ERS Past Presidenton behalf of
Nikolai Khaltaev, MD, PhD Chronic Diseases and Health Promotion, WHO, Geneva (CH)
The World Health Organization (WHO): the Global Alliance against Chronic Respiratory Diseases (GARD) project in
Respiratory MedicineRoma, 15 novembre 2006
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Cardiovascular diseases mainly heart disease and stroke
Cancer Chronic respiratory diseases Diabetes
Chronic diseases worldwide
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Chronic diseases in Spain
In Spain, chronic diseases are projected to account for 90% of all deaths
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Chronic Respiratory Diseases
• including 300 million people with asthma,
Hundreds of millions of people have chronic respiratory diseases,
• 80 million people with moderate to severe chronic obstructive pulmonary disease (COPD)
• and millions of others with mild COPD, allergic rhinitis,
and other chronic respiratory diseases, which are often undiagnosed.
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Some widespread misunderstandings about chronic respiratory diseases -
and the reality
87% OF CHRONIC RESPIRATORY DISEASES DEATHS OCCUR IN LOW & MIDDLE INCOME COUNTRIES
REALITY
MISUNDERSTANDINGCHRONIC RESPIRATORY DISEASES MAINLY AFFECT HIGH INCOME COUNTRIES
Upper middle income
countries 5%
Lower middle income countries
48%
Low income countries
34%
High income countries
13%
Projected global distribution of chronic respiratory disease deaths By World Bank income group, all ages, 2005
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
CHRONIC RESPIRATORY DISEASES AFFECT WOMEN AND MEN ALMOST EQUALLY
REALITY
Some widespread misunderstandings about chronic respiratory diseases -
and the reality
MISUNDERSTANDINGCHRONIC RESPIRATORY DISEASES MAINLY AFFECT MEN
Projected global distribution of chronic respiratory disease deaths all ages, 2005
men52%
women48%
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
The global epidemic of chronic respiratory diseases
4 000 000 PEOPLE
DIED FROM CHRONIC
RESPIRATORY DISEASES
IN 2005
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Burden of Major Respiratory Conditions
Source: World Health Report 2003
DALYs* %
Bronchus /Trachea Cancer
Condition Deaths %
Lower Respiratory Infections 6.6 5.8COPD 4.8 1.9Tuberculosis 2.8 2.4Lung/ 2.2 0.8Asthma 0.4 1.0
Total 16.8 11.9
*DALYs = Disability-Adjusted Life-Years
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
What are DALYs?DisabilityAdjustedLifeYears
One DALY: one lost year of “healthy” life
DALY = YLD + YLL
55 65 75
COPDonset death expected
deathage (years)YLL
Years of Life LostYears of Life with Disability
YLD50
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Increasing Burden of Diseases and Injuries:
Change in Rank Order of DALYs*Source: WHO Evidence, Information and Policy, 2005*DALYs = Disability-Adjusted Life-Years
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Burden of COPD• COPD is a major cause of morbidity, death and
disability• The main cause for developing COPD is
tobacco smoking• COPD is not just simply a "smoker's cough",
but a disease that kills per year 3 million people worldwide
• Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
<6.2 .6.2-9.7
9.7-15.7
18.1-19.919.9-22.1
35.5-38.122.1-35.5
15.7-18.1
>38.1no data
World map COPD - Deaths / 1000 year 2000
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
World map COPD – DALYs* / 1000 year 2000
<0.100.10-0.790.80-2.192.20-2.592.60-3.493.50-3.893.90-4.399
>6.704.40-6.69
no data *DALYs: disability-adjusted life year
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
The estimated DALYs* for COPD according to the population of each WHO region for the year 2005
Source: WHO, Evidence and Information Policy, 2005
*DALYs = Disability Affected Life Years
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Prevalence of COPD in Europe
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
0 5000 10000 15000 20000
EUROPEDisease burden (DALYs) in 2000 attributable to selected risk
factors
Indoor smoke from solid fuels Unsafe water, sanitation, and hygiene
Underweight Childhood sexual abuse
Urban air pollution Occupational risk factors for injury
Iron deficiency Unsafe sex
Lead exposure Illicit drugs
Physical inactivity Fruit and vegetable intake
High Body Mass IndexCholesterol
Alcohol Tobacco
Blood pressure
Number of Disability-Adjusted Life Years (000s)
Tobacco
Urban airpollution
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
WHO global approach to control Chronic Respiratory
Diseases
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
As for 17 December 2004: 47 countries haveratified the treaty. On 27 February 2005:
the FCTC has entered into force and has become an International law.
Today the FCTC has 140 parties(16 November 2006)
Framework Convention on Tobacco Control (FCTC)
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
STEP
SuRF
FCTC
Prevention ofAllergy andAllergic AsthmaBased on the WHO/WAO Meeting on thePrevention of Allergy and Allergic AsthmaGeneva,8-9 January 2002
WHO/MNC/CRA/03.2
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
A new way to prevent and control chronic respiratory diseases
Global Alliance against Chronic Respiratory
Diseases
The enormous human suffering caused by chronic respiratory diseases (CRD) has been recognized by the
53rd World Health Assembly (May 2000) which requested the Director General to:
• To continue giving priority to prevention and control of noncommunicable diseases, including CRD, with special emphasis on developing countries and other deprived populations;
• To coordinate, in collaboration with the international community, global partnerships and alliances for resource mobilization, advocacy, capacity building and collaborative research
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
What is the value added of this new way?
The value added of developing an alliance with specialized national and international NGOs is to:
• To share responsibilities and building on each partner's expertise
• To combine the partners' strengths and knowledge, thereby achieving results that no one partner could attain alone.
• To improve coordination between existing governmental and nongovernmental programmes, which avoids duplication of efforts and wasting of resources.
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Before GARD = lack of coordination, competition
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
WHO calls for a global and coordinated effort
to fight Chronic Respiratory Diseases
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD Global Launch, 28 March 2006, Beijing, People's Republic of China
"GARD will provide an effective form in which health care workers, institutions and governments from all countries may jointly work to mobilize the entire population in efforts to prevent and control chronic respiratory diseases".
Dr Longde Wang Vice Minister of Health, People's Republic of China
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD“I am happy to hear that the Global Alliance against Chronic Respiratory Diseases is now in place as a global team. As a team, each member will contribute his or her unique strengths, just like in football. Together, the Alliance's teamwork will provide help to the hundreds of millions of people who suffer from chronic respiratory diseases, including those in my country who do not have access to essential treatments.”
Pele, soccer legend
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD"Reaching a major goal like conquering chronic respiratory diseases is similar to a marathon run: it's a big effort but with energy, knowledge, support and the will to win, it can be done. I am convinced that the Global Alliance for Respiratory Diseases will win the battle against chronic respiratory disease, which kills four million people a year"
Rosa Mota, former Portuguese marathon runner and Olympic champion
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD contribution to prevent and control chronic diseases
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD VisionA world where all people breathe freely
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GoalTo improve global lung health
ObjectiveTo initiate a comprehensive approach to fight chronic
respiratory diseases through:
• developing a standard way of obtaining relevant data on chronic respiratory disease risk factors;
• encouraging countries to implement health promotion and chronic disease prevention policies; and
• making recommendations of simple strategies for management of chronic respiratory diseases.
GARD Goal and Objective
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
June 2004
WHOACAAIALATARIAATS EAACIEFAERSFILHAFIRSGA2LENGINAGOLD NHLBIWAOWHO-CC DU
Jan 2005
WHOAAAAIAAAFACAAIARIAATSEAACIEFAERSFILHAFIRSGA2LENGINAGOLDICCINTERASMAKAFNHLBIWAOWHO-CC DUWHO-CC UCMWONCA
February 2006
WHOAAA (D. Vervloet, France)AAAAI (E. Simon, CAN)AAAF (R. Pawankar, JAP)ACAAI (M. Blaiss, USA)AIMAR (C. Donner, ITA)ALAT (C. Luna, ARG)APAACI (T. Fukuda, JAP)APRS (Y. Fukuchi, JAP)ARIA (J. Bousquet, FRA)ATS (P. Wagner, USA)CCM (D. Greco, ITA)CNR-INMM (G. Rasi, ITA)DLHA (DK)EAACI (U. Wahn, GER)ECARF (T. Zuberbier, GER)EFA (S. Palkonen, FIN)ERS (R. Dahl, DK)FEMTEC (U. Solimene, ITA)FILHA (M. Nieminen, FIN)FIRS (A. Turnbull, SWI)GA2LEN (P. Van Cauwenberge, BEL)GINA (P. O’Byrne, CAN)GOLD (L. Fabbri, ITA)ICC (L. Grouse, USA)INTERASMA (I. Ansotegui, SPA)IPRAIS (J. Warner, UK)IPCRG (A. Ostrem, UK)IRCCS-SR (S. Bonini, ITA)
15
21
41GARD
Participants from
European Region
Oct 2002
WHOEFA
Jan 2003
WHOEFAARIA
IUATLD (N. Billo, FRA)KAF (Y. Kim, KOR)KTL (P. Puska, FIN)NHLBI (B. Alving, USA)RSP (A. Chuchalin, RUS)SFAIC (G.Pauli, FRA)SPAIC (M. Morais de Almeida)SPLF (B. Housset, FRA)TTS (A. Kocabas, TUR)WAO (C. Baena-Cagnani, ARG)WHO-CC DU (S. Makino, JAP)WHO-CC GU (G. Joos, BEL)WONCA (A. Loh, SIN)
2 3
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD is part of WHO's work to prevent and control chronic
diseases
Comprehensive and integrated action is the means to prevent and control chronic diseases
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD will contribute to the global goal
• A 2% annual reduction in chronic disease death rates worldwide, per year, over the next 10 years to 2015.
• The scientific knowledge to achieve this goal already exists.
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
9 out of 10 lives saved: low and middle income countries
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Economic gain: billions
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD Working Groups:Estimate population needs and advocate
WG.1- Burden, risk factors and surveillance (G Viegi, S Buist, Y Fukuchi)
WG.2- Awareness and advocacy (C Lenfant, A Turnbull, P van Cauwenberge)
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD Working Groups:Formulate and adopt policy
WG.3- Prevention and health promotion (M Boland, A Custovic)
WG.4- Diagnosis of CRD and allergy (K Rabe, S Wenzel)
WG.5- Control of CRD and allergies, Availability and affordability of drugs (J Bousquet, E Bateman, L Fabbri, C van Weel)
WG.6- Pediatric asthma (C Baena-Cagnani, E Mantzouranis, FER Simons, E Valovirta)
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
GARD governanceWHO: administrative secretariat
Leader: N.Khaltaev
Steering Committee: GARD administrative leader; GARD chair; GARD co-chair
Advisory Committee: in total 15 persons *GARD administrative leader; GARD chair; GARD co-chair *6 persons from scientific organisations, defined One person from each of the following member categories: *International governmental organizations *Nongovernmental organizations *National government - developed country *National government - developing country *Foundations*Academies and research institutes
Scientific Committee Work group chairs
Chairs of National GARD Committee
ExecutiveCommittee
(n=15)
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Towards a Global Alliance against Chronic Respiratory Diseases at Country Level
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Desired outcome at country level: initiated or upgraded CRD surveillance, prevention and control programme in the country
Approach: building an Alliance against Chronic
Respiratory Diseases at country level
HOW?
GARD - country
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
1. The basics of CRD surveillance, prevention and control programme are already in place in the country. If this is not true, the commitment to initiate a CRD programme shall be evident in the country.
2. The Ministry of Health of the country explicitly requests help to WHO and its partners for the development of an upgraded plan for surveillance, prevention and control of CRD
What are the necessary conditions that have to be in place in order to pursue the idea of developing a GARD-Country?
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
What is the value added?
Do the benefits outweigh the risks associated?
1. Is there the need for a Global Alliance against Chronic Respiratory Diseases at country level to upgrade the CRD surveillance, prevention and control programme?
This is a strategic allianceBetween organizations drawn from the different sector of societies (government, business, NGOs)Who commit to work collaboratively towards the common goal to improve lung healthIn which all partners contribute from their core expertiseShare risksAnd benefits by achieving their own, each others, and the overall goal of the alliance.
What are the steps to develop a GARD – Country?
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Value AddedGARD – Country shall act as a
coordination and creation of a momentum that invites new inputs from various stakeholders,
in order to become a true national response to the need of initiating/upgrading the National CRD Programme.
It shall focus on what single partners cannot achieve alone:• Coordinating already existing activities related to CRD• Exchanging sound and relevant information• Raising greater awareness on CRD and their risk factors as well as on how to prevent and treat them• Generating political commitment at country level• Raising additional resources
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
2. GARD Country Coordinator
3. Making an inventory of stakeholders
4. Approaching other partners
5. Exploratory workshop
6. Terms of Reference
7. Structure
8. Don't forget to review your work from time to time
What are the steps to develop a GARD – Country? (cont.)
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
Ministry of HealthGARD Focal Point
GARD - CountryGARD - Country Coordinator
Universities
Hospitals
Professional Societies
Patients' Associations
National NGOs involved in community-
based interventions
Bilateral cooperative
agencies
Multilateral cooperative
agenciesPrivate sector representative
s
International NGOs involved in
community-based
interventions
WHO
General MeetingPlanning Group Secretariat
Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard
www.who.int/respiratory/gard
PARLEMENT EUROPÉEN
2004
2009
Commission de l'industrie, de la recherche et de l'énergie
27.10.2006 PE 380.783v01-00
AMENDMENTS 99-138
Projet de recommandation pour la deuxième lecture (PE 378.823v01-00) Jerzy Buzek Council common position for adopting a Decision of the European Parliament and of the Council concerning the Seventh Framework Programme of the European Community for research, technological development and demonstration activities (2007 - 2013)
Council Common Position (12032/2/2006 – C6-0318/2006 – 2005/0043(COD))
Amendment by Jerzy Buzek on behalf of the PPE-ED Group, Philippe Busquin on behalf of the PSE Group, Vittorio Prodi on behalf of the ALDE Group and Umberto Guidoni on behalf
of the GUE/NGL Group
Amendment 114 Annex I, Chapter I "Cooperation", Theme 1 "Health", Subtitle "Activities", bullet 2, indents 3
and 4
- Translational research in infectious diseases: to address drug resistance, the global threats of HIV/AIDS, malaria and tuberculosis, as well as Hepatitis C and potentially new and re-emerging epidemics (e.g. SARS and highly pathogenic influenza).
- Translational research in major diseases – cancer, cardiovascular disease, diabetes/obesity; rare diseases; other chronic diseases including rheumatoid diseases, arthritis and musco-skeletal diseases: to develop patient-oriented strategies from prevention to diagnosis with particular emphasis on treatment, including clinical research. Aspects of palliative medicine will be taken into account.
- Translational research in infectious diseases: to address drug resistance, the global threats of HIV/AIDS, malaria and tuberculosis, as well as Hepatitis and potentially new and re-emerging epidemics (e.g. SARS and highly pathogenic influenza).
- Translational research in major diseases – cancer, cardiovascular disease, diabetes/obesity; rare diseases; other chronic diseases including arthritis, rheumatic and musculo-skeletal diseases and respiratory diseases including those induced by allergies: to develop patient-oriented strategies from prevention to diagnosis with particular emphasis on treatment, including clinical research and the use of active ingredients. Aspects of palliative medicine will be taken into account.
Or. en
Justification
Amendment tabled with a view to reaching an agreement with Council