NON COMMUNICABLE DISEASES

Prevention and Control

Integrated Community Based NCD Prevention & Control Program

Four Major Communicable Diseases

• Cardiovascular Diseases

• Cancer

• Chronic Obstructive Pulmonary Disease

• Diabetes Mellitus

WHO Statistics

• 19 May 2008 | Geneva - The global burden of disease is shifting from infectious diseases to noncommunicable diseases, with chronic conditions such as heart disease and stroke now being the chief causes of death globally.

• In the Philippines, increasing life expectancy, urbanization and lifestyle changes have brought about a considerable change on the health status of the country. Globalization and social change has influenced the spread of non-communicable or lifestyle/degenerative diseases by increasing exposure to risk.

• Mortality statistics in 2002 showed that 7 out of 10 leading causes of deaths in the country are diseases which are lifestyle related: diseases of the heart and the vascular system, cancers, chronic obstructive pulmonary diseases, accidents, diabetes, kidney problems.

These diseases are linked by three major risk factors

• Tobacco smoking

• Physical inactivity

• Unhealthy diet

Risk factors with the corresponding prevalence rates:

• Physical inactivity – 60.5%• Smoking – 34.8%• Hypertension – 22.5% (SBP>140 or DBP>90)• Hypercholesterolemia – 8.5% • Obesity – 4.9% • Diabetes – 4.6%

How to reduce the exposure of populations and individuals to the risk factors for NCDs

• Prevent a major proportion of the NCD burden by reducing the exposure of populations to tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol, using proven measures affordable in all countries.

How to reduce the exposure of populations and individuals to the risk factors for NCDs

• Different settings may be considered for action, particularly schools, workplaces, households and communities.

• Health financing must be sustained by innovative approaches like earmarking revenue from alcohol and tobacco taxes.

Policy implementation steps

• Protect people from tobacco smoke, warn and enforce bans on tobacco advertising, promotion and sponsorship.

• Raise taxes on tobacco and alcohol • Restrict access to retailed alcohol and

enforcing bans on advertising • Reduce salt intake and salt content of food

Policy implementation steps

• Replace trans-fat in food with polyunsaturated fat

• Promote public awareness about diet and physical activity

Causes and Risk Factors of Major NCDs

HYPERTENSION

HYPERTENSION

• defined as a sustained elevation in mean arterial pressure (CO x SVR) + CVP

• It is not a single disease state but a disorder with many causes, a variety of symptoms, and a range of responses to therapy

• Hypertension is also a major risk factor for the development of other CVDs like coronary heart disease and stroke.

Etiology /Cause

HYPERTENSION

• classified into primary and secondary hypertension– Primary• no definite cause• also called essential hypertension or idiopathic

hypertension• About 90% of all hypertensives have primary

hypertension– Secondary• usually the result some other primary diseases leading

to hypertension such as renal disease.

RISK FACTORS

HYPERTENSION

• Family history• Advancing age• Race• High salt intake• Gender

Controllable Risk Factors

• Diet • Activity level• Weight• Stress levels• Drinking habits• Smoking habits

Key Areas for Prevention of Hypertension:

PREVENTION

• Encourage proper nutrition – reduce salt and fat intake.

• Prevent becoming overweight or obese – weight reduction through proper nutrition and exercise.

• Smoking cessation • Identify people with risk factors and

encourage regular check-ups for possible hypertension and modification of risk factors.

CORONARY ARTERY DISEASE

CORONARY ARTERY DISEASE

• Is a heart disease caused by impaired coronary blood flow.

• It is also known as Ischemic Heart Disease.• When the coronary arteries become narrowed

or clogged, supply of blood and oxygen to the heart muscle is affected.

ETIOLOGY/CAUSES

CORONARY ARTERY DISEASE

• Most common cause: atherosclerosis• Atherosclerosis usually occurs when a person

has high levels of cholesterol in the blood• In diabetes mellitus, atherosclerosis is

accelerated, often resulting in coronary artery disease, myocardial infarction and stroke.

RISK FACTORS

CORONARY ARTERY DISEASE

• Elevated blood lipids / cholesterol

• Smoking / Tobacco Use

Key Areas for Prevention of CAD• Promote regular physical activity and exercise• Encourage proper nutrition • Maintain body weight and prevent obesity• Advise smoking cessation for active smokers and

prevent exposure to second-hand smoke by family members, friends and co-workers of active smokers

• Early diagnosis, prompt treatment and control of diabetes and hypertension

CEREBROVASCULAR DISEASE / STROKE

CEREBROVASCULAR DISEASE / STROKE

• loss or alteration of bodily function that results from an insufficient supply of blood to some parts of the brain

• Stroke is one of the leading causes of disability. It can lead to weakness or paralysis usually one side of the body. Often, if stroke is massive and severe, it can cause death.

Etiology / Causes

CEREBROVASCULAR DISEASE / STROKE

• three types : thrombotic stroke, embolic stroke and hemorrhagic stroke.

• Almost all strokes are caused by occlusion of cerebral vessels by either thrombi or emboli.

CEREBROVASCULAR DISEASE / STROKE

• The most fatal type of stroke is due to intracerebral hemorrhage, that is, rupture of intracerebral blood vessels.

RISK FACTORS

CEREBROVASCULAR DISEASE / STROKE

• Increasing age• Sex• Heredity (family history)• Hypertension• Cigarette smoking• Diabetes mellitus• Heart disease

CEREBROVASCULAR DISEASE / STROKE

• High RBC count• Season and climate• Socio-economic factor• Excessive alcohol intake• Certain kinds of drug abuse

Key Areas for Prevention of

Stroke

CEREBROVASCULAR DISEASE / STROKE

• Treatment and control of hypertension• Smoking cessation and promoting a smoke free

environment• Prevent thrombus formation in rheumatic heart

disease and arrhythmias with appropriate medications

• Limit alcohol consumption• Avoid intravenous drug abuse and cocaine• Prevent all other risk factors of atherosclerosis

CANCER

CANCER

• uncontrolled growth of abnormal cells in the body.

• Normal body cells vs. cancer cells

• Spreading of cancer?

• Role of immune system?

CAUSES

CANCER

• Heredity / Family History • Carcinogens• Chemicals and Environmental Agents• Benzopyrene• Nitrosamines• Radiation• Viruses

COPD

Chronic Obstructive Pulmonary Disease

COPD

• A progressive disease that makes it hard to breathe.

• Can cause coughing, SOB, chest tightness and other symptoms

COPD

• In COPD, less air flows in and out if the airways because of one or more of the following:– The airways and air sacs lose their elastic quality– The walls between the air sacs are destroyed– The walls of the airways become thick and

inflamed– The airways make more mucus than usual, which

can clog them

COPD

• Two main forms:

– Chronic bronchitis– Emphysema

CAUSE

COPD

• The primary cause is tobacco smoke (including second-hand or passive exposure)

• Exposure to indoor air pollution

RISK FACTORS

COPD

• Indoor air pollution• Outdoor air pollution• Occupational dusts and chemicals• Frequent lower respiratory infection during

childhood

PREVENTION AND CONTROL

COPD

• Raise awareness about the global epidemic of the chronic diseases

• Create more healthy environments, especially for poor and disadvantaged populations

• Decrease common chronic disease risk factors• Prevent premature deaths and avoidable

disabilities from major chronic dieases

PROGRAMS

• WHO Framework Convention on Tobacco Control (WHO FCTC)

• Global Alliance against Chronic Respiratory Diseases

DIABETES MELLITUS

DIABETES MELLITUS

• a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces.

DIABETES MELLITUS

• Type 1 diabetes is characterized by a lack of insulin production.

• Type 2 diabetes is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.

• Gestational diabetes is hyperglycaemia that is first recognized during pregnancy.

CAUSES

TYPE 1

• Type 1 diabetes is believed to be an autoimmune disease.

• Environmental factors, including common unavoidable viral infections, may also contribute to type 1 diabetes

TYPE 2

• Type 2 diabetes has strong genetic links, meaning that type 2 diabetes tends to run in families.

RISK FACTORS

TYPE 1

• Type 1 diabetes is most common in people of non-Hispanic, Northern European descent (especially Finland and Sardinia), followed by African Americans, and Hispanic Americans. It is relatively rare in those of Asian descent.

• Type 1 diabetes is slightly more common in men than in women.

TYPE 2• High blood pressure• High blood triglyceride (fat) levels • Gestational diabetes or giving birth to a baby

weighing more than 9 pounds • High-fat diet• High alcohol intake • Sedentary lifestyle • Obesity or being overweight • Ethnicity• Aging

PREVENTION

TYPE 2

• Control weight to normal or near-normal levels• Regular exercise• Keep alcohol consumption low.• Quit smoking• If a person has high blood fat levels (such as high

cholesterol) or high blood pressure, take all medications as directed.

• Lifestyle modifications and/or certain medications can be used in people with prediabetes

PREVENT COMPLICATIONS• Tight glucose control• Quit smoking• Maintain a healthy weight• Increase physical activity levels• Drink an adequate amount of water and avoid consuming too

much salt.• The skin should be taken care of; keep it supple and hydrated

to avoid sores and cracks that can become severely infected.• The feet should be washed and examined daily