non-communicable diseases: an overview (jeffrey sturchio)

8/6/2019 Non-Communicable Diseases: An Overview (Jeffrey Sturchio)

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Meeting the Challenge of

Non-Communicable Diseases

Dr. Jeffrey L. SturchioPresident & CEOGlobal Health Council

Journalist to Journalist TrainingNational Press Foundation

June 12, 2011


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Globalization and health

In an age of globalization and growing insecurity, health is

everybodys business

With the impact of global transportation and communications

networks, a SARS outbreak in China can reverberated rapidlyfrom Canada to Cairo

In an interconnected and interdependent world, bacteria and

viruses travel almost as fast as e-mail messages and money

flows.

Gro Harlem Brundtland, former Director-General, World

Health Organization (2005)


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Global health matters

Global health affects everyone disease knows no borders

Infectious diseases such as avian influenza, tuberculosis, SARS and

West Nile Virus can spread from one country to another

Other health challenges such as HIV/AIDS have a major global political

and economic impact

Good health is the foundation for building a stable economy

Poor health hinders ones ability to take advantage of educational

opportunities or hold a job

Poor health undermines countries development and trade and can

reinforce the cycle of poverty and political instability.


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Impact of global crises on health

Equitable access to health care, and greater equity inhealth outcomes are fundamental to a well-functioningeconomy.Health had no say in the policies that led to

the financial crisis or made climate change inevitable.But the health sector will bear the brunt of theconsequences.....A world that is greatly out of balancein matters of health is neither stable nor secure.

Margaret Chan, The impact of global crises on health: money, weatherand microbes, Address at the 23rd Forum on Global Issues, Berlin,Germany, March 18, 2009.http://www.who.int/dg/speeches/2009/financial_crisis_20090318/en/


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Non-communicable diseases

Non-communicable diseases (NCDs) are the leading cause of deathand disability worldwide; they account for 60 percent of all deathsglobally

People living in developing countries are more likely to develop anddie prematurely from chronic disease

Have limited access to comprehensive health services for NCDs Live in countries that do not have effective policies for NCDs (tobacco, alcohol,

air pollution, etc.)

In addition to their devastating impact on health, NCDs have amajor socio-economic impact on individuals, families, communities,and countries

There is an urgent need to raise the profile of NCDs on theinternational development agenda

The burden of chronic disease will account for over 75 percentof deaths by 2030


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Health Statistics and Informatics

Ten leading causes of burden of disease,world, 2004 and 2030


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The World Economic Forum named NCDs the third largest economic

risk facing the globe in 2010


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Many of the risk factors associated with NCDs are related to

modifiable behaviors


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SOURCE: Geneau R, Stuckler D, McKee M, et al. Raising the priority of preventing chronic diseases: a politicalprocess. Lancet 2010; 376: 1689-98.


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Cardiovascular Diseases

The leading cause of death worldwide, accounting for 17 million

deaths in 2005

Of these, 7.2 million were due to heart attacks and 5.7 million

due to stroke

Include coronary heart disease (heart attacks), cerebrovascular

disease, raised blood pressure (hypertension), peripheral artery

disease, rheumatic heart disease, congenital heart disease, and

heart failure

If current trends continue, WHO estimates that 23.6 million peoplewill dies from cardiovascular disease by 2030


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Chronic respiratory diseases (CRDs)

Include asthma, respiratory allergies, chronic

obstructive pulmonary disease (COPD), occupational

lung diseases, sleep apnea syndrome and pulmonary

hypertension Collectively, CRDs account for 4 million deaths per

year; COPD is the fourth leading cause of death

worldwide

Many CRDs are preventable, although they often fail

to receive adequate attention from the health care

system


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Cancers

A leading cause of death group worldwide, accounting for 7.4million deaths in 2004

The global cancer burden has doubled in the past 30 years; by

2020, the cancer burden of 2000 is expected to double again

More that 70 percent of cancers occur in low- and middle-income countries

The leading type of cancer is lung cancer, accounting for 1.3

million deaths per year

In less developed countries, the leading type of cancer formen is lung cancer, followed by liver cancer; the leading type

for women is breast cancer followed by cervical cancer


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Diabetes

Worldwide, over 220 people had diabetes in 2004

Nearly 80 percent of diabetes deaths occur in low- and

middle-income countries

WHO estimates that diabetes deaths will doublebetween 2005 and 2030

Causes kidney failure, diabetic retinopathy, and

diabetic neuropathy; increases the risk of heart disease

and stroke

43 million pre-school children worldwide are obese

or overweight


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60 per cent of the worlds total deaths are due to non-

communicable diseases, many of which are preventable


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90 per cent of people dying prematurely from NCDs live in

developing countries


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NCDs are among the top ten causes of causes of death in every

income group


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Without action, Africa will witness the largest increase in deaths

from NCDs in 2015 (compared to 2004). South East Asia and the

Western Pacific will have the highest absolute number of deaths.


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Factors that contribute to the rise ofNCDs

Rapid urbanization has led to changes in diet, physical activity,

and environmental exposure

Decreases in the price of animal based products, sweeteners,

and oils over the past two decades have contributed todietary changes

Increasing availability of tobacco products as a result of

expanding markets and lack of protective trade policies

Lack of knowledge about chronic disease and poor

understanding of contributing risk factors

Shifting patterns of behavior due to globalization and

increased media exposure/marketing


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Economic impact ofNCDs

NCDs reduce the economic productivity of individuals and causemany families to fall into poverty The long-term nature of treatment and care for chronic disease results in

significant household expenditures over prolonged periods of time andinability of the household to accumulate savings

Indian households that include a family member with a chronic disease are 40

percent more likely to fall into poverty The expense of treatment often deters individuals from seeking

treatment In Nigeria, over 60 percent of cancer patients failed to complete their

chemotherapy treatments because of the prohibitive cost of the drugs

NCDs also have a severe impact on the economies of countries Over the next decade, China is estimated to lose over $550 billion in national

income due to cardiovascular disease

In Central Asia, chronic diseases may reduce workers labor effort by 7 to 30percent


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Common myths that surround NCDs that people knowingly choose toengage in unhealthy behaviors (smoking, drinking, diet), or that chronic

diseases related to aging are inevitable may be detrimental to collective

action

Policies that aim to regulate individual behavior (taxes on soft drinks,

cigarettes) may be seen as impinging on individual agency

Weak health information systems prevent adequate surveillance of chronic

disease in many developing countries; without data, it is difficult to argue

for the prioritization of NCDs based on the burden of disease

Although international advocacy for NCDs is growing, greater efforts are

needed on the local level to raise the profile of NCDs on national agendas

Another myth around NCDs is that low- and middle-income countries

should give priority to infectious diseases. However, this approach does not

align with the burden of disease in these countries.

Why have NCDs been neglected?


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Interventions for NCDs

In 2007, a Lancet Series on NCDs identified three highly cost-effective

interventions for preventing NCDs: tobacco control, salt reduction,

combined drug treatment for people at high risk of cardiovascular disease

Tobacco control and salt reduction could prevent almost 14 millions deaths

over the next decade, at a cost of less than US $0.40 per person per year

Aspirin and generic drugs to lower blood pressure and cholesterol couldprevent 18 million deaths over the next decade, at a cost of approximately

$1.10 per person per year

National policies and legislation to limit the use of harmful substances,

such as tobacco, alcohol, and unhealthy foods

Behavior change campaigns to educate about the risks of chronic disease and

encourage positive, healthy behaviors

Strengthening of health systems and additional prevention, screening,

treatment, and care services targeted to chronic disease


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Funding for NCDs

Funding for NCDs is severely lacking; in 2007, only 2.3 percent($503 million) of overall development assistance for health wasdedicated to NCDs Less than 15 percent of the WHOs agenda is allocated to chronic disease

Less than 2 percent of the total health budget of the Gates Foundation andthe World Bank is allocated to chronic disease

Currently, there is no OECD/DAC Reporting System code to trackfunds for NCDs

In low- and middle-income countries, many governments areincreasing domestic expenditures for health, but investment inchronic disease is lacking

However, between 2001 and 2008 donor funding to developingcountries for NCDs increased by over 600 percent. This suggests agrowing recognition and willingness to address the increasingburden of NCDs.


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Next steps for NCDs

High-level Meeting of the United Nations General Assemblyon the Prevention and Control of Non-communicable Diseases

on September 19, 2011

UNGA will focus on three major themes related to chronic

disease: The rising incidence, developmental and other

challenges and the socioeconomic impact of NCDs and

their risk factors;

Strengthening national capacities, as well asappropriate policies, to address prevention and control

of non-communicable diseases;

Fostering international cooperation, as well as

coordination, to address non-communicable diseases.


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NCD Alliance


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NCD Alliances 10 Asks

for the UN NCDs Summit

1. Commit to a whole-of-government response through costed national plans for NCD

prevention and treatment

2. Establish an NCDs Partnership, linked to WHO, to coordinate follow up action with member

states, other UN and multilateral agencies, foundations, NGOs and private sector

3. Increase national and international resources for NCD prevention and treatment4. Include NCDs in future global health and development goals

5. Accelerate implementation of Framework Convention on Tobacco Control (FCTC)

6. Reduce dietary salt, sugar, saturated and trans-fats and harmful use of alcohol

7. Implement strategies to encourage physical activity and improve diet

8. Strengthen health systems through integration of NCD prevention and treatment

9. Increase access to affordable, quality-assured essential medicines and technologies to

prevent and treat cancer, cardiovascular disease, chronic respiratory disease and diabetes,including vaccines and palliative care

10. Establish a high level Accountability Commission on NCDs with cross sector

representation to monitor Summit commitments.


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Key dates

WHO/ UNDESA Regional Summit Consultations South-East Asia (14-17 Feb, Dhaka, Bangladesh)

Americas (24-25 February, Mexico City, Mexico)

Western Pacific (25-27 March, Seoul, South Korea)

Africa: TBD

NCD Alliance Side Event: 55th Session of the Commission on the Status of Women,

22 Feb4 Mar, New York Partners in Health / NCD Alliance Conference on NCDs of the Bottom Billion, 2-3

March, Harvard University

Oxford Health Alliance Annual Meeting on NCDs, 14-15 April 2011, Oxford, UK

NCDnet Global Forum, 27 April, Moscow

Russia Ministerial Conference on NCDs, 28-29 April, Moscow

64th World Health Assembly, 16-25 May, Geneva

Global Health Council Annual Conference (Theme: NCDs), 13-17 June, Washington,DC

UN civil society consultation, June 16

UN High-Level Meeting, 19-20 September 2011 in New York Three RoundtableSessions


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A role for public/private partnerships

Private sector companies can also make contributions to

health and development by building partnerships to address

these challenges

Working together, we can achieve more than any singleorganization or country can do on its own

Public/private partnerships offer an important mechanism

that works to combine the complementary resources and

expertise of the public and private sectors to achieve health

goals


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The value of collaboration

The marketplace is not the answer to all questions facing

society. Likewise, the public sector cannot solve all social

problems. But the combination of public and private efforts,

when harnessed together, in an effort to achieve a clear and

shared health objective, provides a powerful force that

exceeds the sum of its separate efforts.

Dr. William H. Foege, in Ethics and the Pharmaceutical Industry

(2005)


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Framework for Corporate Pledges to

Support NCD Prevention & Control

Health Promotion and Risk Prevention

1) Nutrition &

healthy diets

(A,H)

2) Physical activity

& sports (B,H)

3) Tobacco control

(C,D,H)

4) Alcohol

responsibility

(C,D, H)

5) Health education &

wellness initiatives

(C,D, G, H, I)

Reformulation

Marketing

Portion size

Other

School/youth

Urban design

Other

Smoke free

workplaces

Cessation support

Other

Counsel/support

Other

Awareness

Risk management

Wellness incentives

Other

Health System Strengthening

6) Medicines &

Vaccines (E)

7) Patient diagnosis

& Treatment

(E,F)

8) Healthcare

professional

training (D,F,G)

9) Patient monitoring

& follow-up (D,G)

10) Governance (I)

R&D for innovative

medicines for NCDs

Affordable &

accessible treatment

Other

Leveraging primary

care infrastructure

Innovative delivery

models

Other

Building networks

On-line training

Internships

Other

Remote check-ups

Disease management

Other

Self-regulatory codes

Industry commitments

Best practices

Other

A. Food/beverage, food service & agriculture B. Sporting Goods

C. Employers D. Health Insurers & healthcare providers

E. Pharmaceuticals F. Medical devices & diagnostics

G. Information &/Communications Technologies (ICTs) H. Media

I. Cross-industry J. Other


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The way forward

We need to find the best solutions and scale them up --across borders, across sectors, and throughcollaboration and cooperation among all stakeholders

Progress is possible -- and there have been encouragingdevelopments in the past several years with respect todealing effectively with major global health issues

Continued partnerships in global health provide thebest way to build on this momentum -- and offer the

best hope for those living with both infectious andchronic diseases in the developing world

non-communicable diseases: an overview (jeffrey sturchio)

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