Global Surveillance, Global Surveillance, Prevention and Control Prevention and Control of Chronic Respiratory of Chronic Respiratory

DiseasesDiseasesdr. Juliandi Harahapdr. Juliandi Harahap

dr. Rina Ameliadr. Rina Amelia

IntroductionIntroduction Chronic respiratory diseases are chronic

diseases of the airways and the other structures of the lungs.

Major preventable chronic respiratory diseases include asthma and respiratory allergies, chronic obstructive pulmonary disease (COPD), occupational lung diseases, sleep apnea syndrome and pulmonary hypertension.

Chronic Respiratory Diseases kill more than four million people every year and affect hundreds of millions more.

Respiratory symptoms are among major causes of consultation at primary health care centres.

These diseases erode the health and well-being of the patients and have a negative impact on families and societies.

Women and children are particularly vulnerable, especially those in low and middle income countries, where they are exposed on a daily basis to indoor air pollution from solid fuels for cooking and heating.

In high income countries, tobacco is the most important risk factor for chronic respiratory diseases, and in some of these countries, tobacco use among women and young people is still increasing.

The Burden of Chronic Diseases

80% of chronic disease deaths occur in low and middle income countries.

The threat is growing – the number of people, families and communities afflicted is increasing.

This growing threat is an under-appreciated cause of poverty and retards the economic development of many countries.

Chronic diseases were estimated 58 million deaths from all causes in 2005.

Chronic diseases account for twice as many deaths as all communicable diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined

Only 20% of cases of chronic disease occur in high income countries.

The chronic disease threat can be overcome using existing knowledge.

The solutions are effective – and highly cost effective.

Comprehensive and integrated action at country level, led by governments, is the means to achieve success.

WHO recently launched the Global Alliance against Chronic Respiratory Diseases (GARD).

GARD brings together the combined knowledge of national and international organizations, institutions and agencies to improve the lives of millions of people affected by chronic respiratory diseases.

Risk Factors Major risk factors include:

1. tobacco smoke2. second hand tobacco smoke3. other indoor air pollutants4. outdoor air pollutants5. allergens6. occupational agents.

Possible risk factors include:1. diet and nutrition2. post infectious chronic respiratory diseases.

Prevention of these risk factors will have a significant impact on morbidity and mortality.

Preventable Chronic Respiratory Diseases: A Major

Global Health Problem Hundreds of millions of people of all

ages (from infancy to old age) suffer from preventable chronic respiratory diseases and respiratory allergies in all countries of the world.

More than 500 million of these people live in low and middle income countries or deprived populations.

Preventable chronic respiratory diseases are increasing in prevalence, particularly among children and elderly people.

The burden of preventable chronic respiratory diseases has major adverse effects on the quality of life and disability of affected individuals.

Many risk factors for preventable chronic respiratory diseases have been identified and efficient preventive measures established.

Effective management plans have been shown to reduce the morbidity and mortality caused by chronic respiratory diseases.

Prevention and management plans concerning chronic respiratory diseases are fragmented and need to be coordinated

The Global Alliance against Chronic Respiratory

Diseases (GARD) a voluntary alliance of national and

international organizations, institutions and agencies working towards the common goal of improving global lung health.

Vision: a world where all people breathe freely.

Goal: to reduce the global burden of chronic respiratory diseases.

Objective: to initiate a comprehensive approach to

fight chronic respiratory diseases. This involves:

developing a standard way of obtaining relevant data on chronic respiratory disease risk factors,

encouraging countries to implement health promotion and chronic respiratory disease prevention policies,

recommending affordable strategies for the management of chronic respiratory diseases.

GARD’s added value:

to provide a network through which collaborating parties can combine their strengths,

to improve coordination between existing governmental and nongovernmental programmes, so as to avoid a duplication of efforts and the waste of resources.

GARD’s approach:

to promote an integrated approach that capitalizes upon strategic synergies on prevention and control between chronic respiratory diseases and other chronic diseases

to consider especially the needs of low and middle income countries and vulnerable populations, fostering country-specific initiatives that are tailored to local needs.

The emphasis on the needs of low- and middle-income countries is appropriate, as most cases of chronic respiratory disease occur in these countries, with communicable diseases (including HIV/AIDS) adding to the burden of chronic respiratory disease morbidity.

GARD Approach GARD will work at international and

national level.

GARD’s planning steps correspond to WHO’s strategic objectives and action plans.

GARD will exploit synergies, building on and complementing existing programmes and projects.

Stepwise Framework

Planning step 1: estimate population need and advocate

for action The basis for action is to estimate disease burden

and population needs, identify risk factors for chronic respiratory diseases and respiratory allergies, and undertake surveillance on chronic respiratory disease risk factors, and trends in disease burden, as well as in costs, quality and affordability of care.

The data will need to be compared between countries (high–income, and low- and middle-income) to define strategies for policy-makers and to assess the impact of chronic respiratory diseases programmes.

There is also a need to advocate for action to combat chronic respiratory diseases in order to raise awareness among all stakeholders and make chronic respiratory diseases a public health priority in all countries.

Planning step 2 : formulate & adopt policy

Implementation will start with pilot studies, developed by local experts and stakeholders in each country, relevant to the needs, resources and setting of that country.

Comprehensive and integrated policies and plans for prevention are vital because they minimize overlap and fragmentation in the health system. Policies and plans to prevent chronic respiratory diseases should therefore Cut across specific diseases and focus on common risk factors’

since many risk factors, such as tobacco smoking and other air pollutants, affect many different diseases.

Encompass promotion, prevention and control strategies. Emphasize a population-based approach, rather than targeting

specifi c subgroups. Integrate activities across settings, such as health-care centres,

schools, workplaces and communities. Link with other government programmes and community-based

actions.

A policy or plan on chronic respiratory diseases should

1. Promote health through the prevention of chronic respiratory diseases and respiratory allergies: by reducing the burden of tobacco smoke and other types of indoor and outdoor pollution, occupational hazards and other relevant risk factors.

2. Recommend simple and affordable diagnostic tools for the diagnosis of chronic respiratory diseases and respiratory allergies

3. Control chronic respiratory diseases and allergies, and ensure drug accessibility

Planning step 3: identify policy implementation steps

Health priorities, geographic variability in risk factors and chronic respiratory diseases, the diversity of national health-care service systems and variations in the availability and affordability of treatments, all require that any recommendations should be adapted locally to ensure their appropriateness to the community in which they will be applied.

GARD action plans developed during the planning step 2 will be collated and rolled out to as many countries as possible. The policy implementation process will follow the stepwise framework the results will be measurable.