plenary session 2 - preventing chronic non-communicable lifestyle related diseases
TRANSCRIPT
Preventing Chronic Non-Communicable Lifestyle RelatedDiseases: A Vital
Investment
Ms. Frances Prescilla CuevasChief Health Program OfficerDegenerative Disease Office
National Center for Disease Prevention and ControlDepartment of Health
Outline of the Presentation
• Global Situation
• Framework for Intervention
• Country Situation
• Way Forward for the Philippines
• Implications to Nursing
MISUNDERSTANDINGS ABOUT CHRONIC DISEASES HAVE CONTRIBUTED TO THEIR GLOBAL NEGLECT
16
Economic Burden of NCDs
Share of Disease Burdens Falling Between Ages
15-69 in Low- and Middle-Income Countries, 2005•A large share of the burden of
NCDs occurs in populations of
working age
•NCDs impose a significant burden
not just on patients, but also on
households, communities,
employers, health care systems,
and government budgets
•E.g., costs associated with
tobacco and obesity in China and
India are about 1-2% of GDP
Source: Lopez and others. 2006. Global Burden of Disease and Risk Factors. New York: Oxford University Press. Data also available World Health Organization. “Burden of Disease Project.” World Health Organization. http://www.who.int/healthinfo/bodproject/en/index.html.
Disease category % Deaths
15-69
% DALYs
15-69
All causes 46% 54%
All NCDs 43% 74%
-Cardiovascular
diseases
38% 72%
-Cancers 62% 81%
All communicable
diseases
35% 32%
Office of the WHO Representative in the Philippines
Macro-economic impact:
• World Economic Forum estimates high risk and
likelihood of negative economic impact from
noncommunicable diseases
• Heart disease stroke and diabetes alone estimated
to reduce GDP between 1-5% in developing
countries
Noncommunicable Diseases
Socio-economic Impact
Office of the WHO Representative in the Philippines
Impact at household level:
• World Bank estimates that one-third of people living on US$1-2 a day die prematurely of noncommunicable diseases
• People in developing countries die younger from noncommunicable diseases, often in their most productive years
• Low-income households suffer from the cost of long term treatment and the cost of unhealthy behaviours
– Cost of caring for a family member with diabetes: 20% of low-income household income
– Poorest households spend more than 10% of their income on tobacco
– Cost of essential drugs to treat and cure cancer makes them unaffordable for the poor
Noncommunicable Diseases
Socio-economic Impact
Study on an “Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension”
• 1st part: Analyzed 3.5-year claims data from 2002-2005
• 2nd part: Conducted a survey of identified PhilHealth beneficiaries with hypertension based on claims data
• Specific aims of the study:
1. Describe the frequency of use of inpatient care for hypertension and costs reimbursed by PhilHealth, using existing claims data on all PhilHealth members admitted for hypertension treatment from 2002 – 2005
2. Assess pre and post-hospitalization medicines access and use and willingness to pay for outpatient medicines of PhilHealth members discharged in 2005 after treatment for hypertension
Study on an “Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension”
• Conclusion:
• Lack of affordable access to outpatient antihypertensive medicines leads to avoidable disease progression and costly inpatient admissions.
• Inpatient care for hypertension and its sequelae is expensive and hypothesize that many hospitalizations could be avoided with appropriate antihypertensive therapy provided in ambulatory care.
• Avoiding expenditures for one hospitalization could pay for one year of anti-hypertensive medicine treatment for three (3) patients.
Study on an “Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension”
• Recommendation:
PhilHealth to explore options for providing outpatient medicines and care benefits for chronic conditions such as hypertension.
• About three-fourths of the diabetes patients had given up diabetes care because of financial difficulties at one time in the past.
• Sixty seven percent (67%) experienced shortage of money because of diabetes-related expenditure, and borrowed money or pawned assets.
• Philhealth coverage was lowest among the informal sector at 15%.
Costs, Availability, and Affordability of Diabetes Care in the Philippines
by Higuchi, et all, WHO, 2008
Causation Pathway
Causation Pathway
Intervention Pathway
Advocacy
Research, Surveillance, Evaluation
“Whole of society” responseCommunity leadership
Intersectoral partnerships
Community mobilization
Health Systems Response(Health Systems Strengthening)Health workforce developmentHealth services organization/deliveryFinancingPeople-centred systems of careFocus on prevention
Health Sector ResponseHealth sector governanceHealth sector leadershipIntegration of NCD prevention and control into national health strategy“Whole of government” response
Political willPolitical leadershipHealthy public policies and laws
Strategic Approach
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Office of the WHO Representative in the Philippines
Cost-effective strategies exist
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The Cost-Effectiveness of NCD Interventions Covers a Wide Range
Selected Cost-effectiveness Ratios for Interventions against NCDsTaxation of tobacco products
DALYs averted per U
S$1
million spent
Cost per D
ALY
Treatment of acute myocardial infarction or heart attach with an
inexpensive set of drugs (aspirin and beta-blocker)
Treatment of acute myocardial infarction with inexpensive drugs plus
streptokinase (costs and DALYs for this are in addition to what
would have occurred with inexpensive drugs only)
Lifetime treatment of heart attack and stroke survivors with a daily
polypill combining four or five off-patent preventive medications
Coronary artery bypass gaft or bypass surgery in specific identifiable
risk cases, such as disease of the left main coronary artery
(incremental to 4)
Bypass surgery for less severe coronary heart disease and lifetime
treatment (incremental to 4)
3-50 20,000-330,000
10-25
600-750
700-1,000
>25,000
Very high
40,000-100,000
1,300-1,600
1,000-1,400
<40
Very small
Source: Jamison and others. 2006. Priorities in Health. Washington, DC: World Bank.
Office of the WHO Representative in the Philippines
There are low cost interventions to prevent
NCDs…
Country NCD Situation
The Philippines is one of the 23 selected countries contributing to around 80% of the total mortality burden attributable to chronic diseases in developing countries, and 50% of the total disease burden caused by non-communicable diseases worldwide.
Fig. 1. Ten Leading Causes of Mortality:
Philippines 1999-2005
0
10
20
30
40
50
60
70
80
90
100
1999 2000 2002 2003 2004 2005
Ra
te
s/1
00k
P
op
ulatio
nDiseases of the Heart
Diseases of the Vascular
system
Malignant Neoplasm
Pneumonia
Accidents
Tuberculosis, all forms
Chronic low er respiratory
diseases
Diabetes Mellitus
Certain conditions originating
in the perinatal period
Nephritis, nephrotic syndrome
and nephrosis
Source: FHSIS-DOH
Prevalence of hypertension, hyperglycemia, dyslipidemia & overweight
1998, 2003 and 2008 Philippine NNS, FNRI
Risk factors1998 2003 2008 Basis
Hypertension 21.0 22.5 25.3 SBP ≥ 140, DBP ≥ 90
Hyperglycemia 3.9 3.4 4.8 FBS > 126 mg/dL
Total cholesterol 4.0 8.5 10.2 ≥ 240 mg/dL
LDL-c 8.1 11.7 11.8 ≥ 160 mg/dL
HDL-c 76.6 54.2 64.1 < 40 mg/dL
Triglycerides 8.7 9.4 14.6 ≥ 200 mg/dL
BMI (Overweight) 20.2 24.0 26.6 BMI ≥ 25.0
Distribution of population by physical inactivity Philippine NNS, FNRI
Physical Inactivity Domains 2003(%)
2008(%)
P-value
Males
Occupational 67.0 76.3 0.0000
Travel-related 91.0 93.8 0.9999
Leisure time physical activity < 2 times per week
90.0 89.1 0.1269
Females
Occupational 82.1 76.2 0.0035
Travel-related 94.3 95.2 0.6022
Leisure time physical activity < 2 times per week
95.5 95.7 0.0001
Current smoking Prevalence
Hazardous alcohol intake
From Pedro, Benavides, & Barba, 2006
CURRENT NCD SITUATION
• STATISTICS SHOWS THAT PREVALENCE OF NCDs and its major RISK FACTORS CONTINUES TO RISE
• THIS SITUATION IN THE COUNTRY IS UNACCEPTABLE
• WHAT WE HAVE BEEN DOING IS NOT ENOUGH
• DRASTIC MEASURES NEED TO BE DONE
PHILIPPINE COMMITMENT
INCLUSION OF NCD PREVENTION
AND CONTROL TO MDG
COMMITMENT OF THE COUNTRY
THROUGH THE MDGMAX INITIATIVE
Announced by the Secretary of Health, Dr. Francisco T. Duque III, during
the 4th Public Health Convention on NCD Prevention and Control last July 2008 convened by the PCPCNCD and affirmed by an Administrative Order operationalizing the Prevention and Control of Lifestyle Related NCDs, the goal is to reduce NCD mortality by 2% per year.
Office of the WHO Representative in the Philippines
Framework for Action,
Philippines
Adoption of an integrated, comprehensive and community based response to NCD prevention and control:
• Focuses on common risk factors
• Encompasses the three levels of disease prevention
• Emphasizes strategies which would benefit entire population
• Integrates across settings
• Makes explicit links to other government programmes and community based organizations
• Emphasizes intersectoral action
Strategic Approach For The Prevention And Control Of Lifestyle Related Diseases
1. Environmental Interventions
2. Lifestyle Interventions
3. Clinical Interventions
4. Advocacy
5. Research, Surveillance, Monitoring and Evaluation
6. Networking and Coalition-Building
7. Health Systems Strengthening
Environmental Intervention:
• Governance
• Policy and legislation
• Creating supportive built environments
Lifestyle Intervention:
• Information and Education
Clinical Intervention:
• Provision of clinical preventive service packages
• Provision of Acute Care, Chronic Care, Rehabilitation Care, and Palliative care
Advocacy:
• Further develop, implement and sustain health promotion initiatives on healthy lifestyle
• Utilize media and social marketing
Research, Surveillance, Monitoring and Evaluation:
• Inclusion of lifestyle-related diseases in the national unified health research agenda
• Development of evidence based interventions
Networking and Coalition Building:
• Collaborate with LGUs, private sector and other partners
Health Systems Strengthening:
• Establish program structure and provide funding for addressing lifestyle-related diseases
• Strengthen human resources capacity
• Facilitate resource mobilization and establish sustainable financing mechanisms
• Strengthen referral mechanism
Healthy City-NCD-Cherian Varghese-China-July 200910/28/2010
Changing times- Need social
engineering
WPR Meeting on NCD Prevention and Control; 3-7 August 200910/28/2010
THE MEDICAL MODEL
DIAGNOSE
TREAT
(FIX)
SCREEN
Focus on Disease.
Individual
Lifestyle
WPR Meeting on NCD Prevention and Control; 3-7 August 200910/28/2010
THE HEALTH PROMOTION MODEL
PREVENT
SUSTAIN
PROMOTE
Focus is on Health
ENABLING
ENVIRONMENT
How then should we educate our nurses?
• Train nurses in health promotion with expertise on population based approaches and not only on the highly clinical individual focused interventions.
• Philippines: link with ADPCN and UP College of Nursing to strengthen and enhance teaching of health promotion and NCD prevention and control in the BSN curriculum
• Train nurses to become highly skilled in policy advocacy, networking and negotiation.
Investing in Nurses
• Dr. Patricia Benner: Educating Nurses –Creating a New Future, Global Alliance for Nursing and Midwifery WHO CC Elluminate Distinguished Lecturer Series advocates on reverting back to educating nurses in Primary Health Care – Public Health- Health Promotion Model.
• Oct 13, 2010 Elluminate Conference
Nursing Coming of Age Globally
• Nurses are knowledge workers who are educationally equipped to deliver knowledgeable health education and care, health promotion and illness prevention in all settings.
• Their work needs to be in Community Health Centers, Primary Health Care, and thus, be enabled to spend less time in higher technology tertiary care centers in order to prevent illness and improve the health of nations.
WPR Meeting on NCD Prevention and Control; 3-7 August 200910/28/2010
Upstream interventions
NCDs
Policies/
lack of it
in other
sectors
WPR Meeting on NCD Prevention and Control; 3-7 August 200910/28/2010
• Cross over
• All sectors to
work for health
• Health in all
policies
• Back to
Primary Health
Care and
Health
Promotion
GUINNESS WORLD RECORDSThe largest aerobics display involved 48,188 participants at Luneta Park
Manila, Philippines, February 16, 2003
Thank you!