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The Global Alliance against Chronic Respiratory Diseases

The Global Alliance against Chronic Respiratory Diseases. Dr Nikolai Khaltaev "Global lung health in 2000's" Antalya, Turkey, 25 – 26 April 2007. The global burden of chronic respiratory diseases Chronic obstructive pulmonary disease (COPD) Asthma

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The Global Alliance against Chronic Respiratory Diseases

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  1. The Global Alliance against Chronic Respiratory Diseases Dr Nikolai Khaltaev"Global lung health in 2000's"Antalya, Turkey, 25 – 26 April 2007

  2. The global burden of chronic respiratory diseases Chronic obstructive pulmonary disease (COPD) Asthma WHO global approach to control chronic respiratory diseases The Global Alliance against Chronic Respiratory Diseases (GARD): a new way to prevent and control chronic respiratory diseases GARD country activities Overview

  3. The global burden of chronic respiratory diseases

  4. Did you know?? 4 000 000PEOPLE DIED FROMCHRONIC RESPIRATORY DISEASES IN 2005

  5. Some widespread misunderstandings about chronic respiratory diseases - and the reality Projected global distribution of chronic respiratory disease deathsBy World Bank income group, all ages, 2005 MISUNDERSTANDING CHRONIC RESPIRATORY DISEASES MAINLY AFFECT HIGH INCOME COUNTRIES REALITY 87% OF CHRONIC RESPIRATORY DISEASES DEATHS OCCUR IN LOW & MIDDLE INCOME COUNTRIES

  6. Some widespread misunderstandings about chronic respiratory diseases - and the reality Projected global distribution of chronic respiratory disease deathsall ages, 2005 MISUNDERSTANDING CHRONIC RESPIRATORY DISEASES MAINLY AFFECT MEN REALITY CHRONIC RESPIRATORY DISEASES AFFECT WOMEN AND MEN ALMOST EQUALLY

  7. Chronic respiratory diseases worldwide Main chronic diseases include: • Cardiovascular diseases mainly heart disease and stroke • Cancer • Chronic respiratory diseases • Diabetes

  8. Chronic respiratory diseases worldwide Hundreds of millions of people have chronic respiratory diseases, • including 300 million people with • asthma, • 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.

  9. Chronic respiratory diseases in Turkey In Turkey, chronic respiratory diseases accounted for 6% of all deaths or 26 220 deaths in 2002.

  10. What are the causes of chronic respiratory diseases?

  11. Burden of Major Respiratory Conditions Condition Deaths DALYs* % % Lower Respiratory Infections 6.6 5.8 COPD 4.8 1.9 Tuberculosis 2.8 2.4 Lung/ 2.2 0.8 Bronchus /Trachea Cancer Asthma 0.4 1.0 Total 16.8 11.9 Source: World Health Report 2003 *DALYs = Disability-Adjusted Life-Years

  12. Disability Adjusted Life Years One DALY: one lost year of “healthy” life DALY = YLD + YLL COPD onset expected death death 55 65 75 YLD YLL 50 Years of Life with Disability Years of Life Lost What are DALYs? age (years)

  13. Increasing Burden of Diseases and Injuries: Change in Rank Order of DALYs* *DALYs = Disability-Adjusted Life-Years Source: WHO Evidence, Information and Policy, 2005 *DALYs: Disability Adjusted Life Years

  14. "When I was 16 years old, my primary doctor told me that smoking would help me lose weight, so every time I started a diet, I also started to smoke.Now I am an invisible picture of COPD disability. I am not yet using oxygen, but I know that day will come. I am unable to do many of the things I love. I cannot dance. I cannot do my own food shopping. I cannot take long walks along the river at sunset with my husband." Elaine L. Ackley, 58 years, New York, United States of America Chronic obstructive pulmonary disease (COPD)

  15. 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 Burden of COPD

  16. World map COPD - Deaths / 1000 year 2000 <6.2 6.2-9.7 . 9.7-15.7 15.7-18.1 18.1-19.9 19.9-22.1 22.1-35.5 35.5-38.1 >38.1 no data

  17. World map COPD – DALYs* / 1000 year 2000 <0.10 0.10-0.79 0.80-2.19 2.20-2.59 2.60-3.49 3.50-3.89 3.90-4.399 4.40-6.69 >6.70 no data *DALYs: disability-adjusted life year

  18. Prevalence of COPD in Europe

  19. Risk factors Passive smoking "Keep it funny, Keep it smoke free" Anti smoke campaign, The Netherlands

  20. The relative importance of Tobacco Smoke and other risk factors relevant for COPD Opposite patterns in different geographic areas EUROPE versus AFRICA Source: World Health Report 2002

  21. EUROPE Disease burden (DALYs) in 2000 attributable to selected risk factors Blood pressure Tobacco Tobacco Alcohol Cholesterol High Body Mass Index Fruit and vegetable intake Physical inactivity Illicit drugs Lead exposure Unsafe sex Iron deficiency Occupational risk factors for injury Urban air pollution Urban air pollution Childhood sexual abuse Underweight Unsafe water, sanitation, and hygiene Indoor smoke from solid fuels 0 5000 10000 15000 20000 Number of Disability-Adjusted Life Years (000s)

  22. Unsafe sex Underweight Unsafe water, sanitation, and hygiene Vitamin A deficiency Zinc deficiency Indoor air pollution Indoor smoke from solid fuels Iron deficiency Alcohol Blood pressure Lack of contraception Tobacco Tobacco Cholesterol Unsafe health care injections Global climate change Lead exposure Occupational risk factors for injury Fruit and vegetable intake 0 10000 20000 30000 40000 50000 60000 70000 Number of Disability-Adjusted Life Years (000s) AFRICA Disease burden (DALYs) in 2000 attributable to selected risk factors

  23. Risks are increasing: burden of disease attributable to tobacco (% DALYs in each subregion) Source: World Health Report, 2002

  24. Source: World Health Report, 2002 Risks are increasing: burden of disease attributable to indoor smoke from solid fuels (% DALYs in each subregion)

  25. Source: World Health Report, 2002 Risks are increasing: burden of disease attributable to urban air pollution (% DALYs in each subregion)

  26. Burden of asthma • Asthma is not just a public health problem for high income countries: it occurs in all countries regardless of level of development. Over 80% of asthma deaths occurs in low and lower-middle income countries. • Asthma deaths will increase by almost 20% in the next 10 years if urgent action is not taken. • According to WHO estimates, 300 million people suffer from asthma and 255 000 people died of asthma in 2005. • Asthma is the most common chronic disease among children.

  27. Global Burden of Asthma 2004

  28. Global Burden of Asthma 2004

  29. Global Burden of Asthma 2004

  30. WHO global approach to control Chronic Respiratory Diseases

  31. Framework Convention on Tobacco Control (FCTC) As for 17 December 2004: 47 countries have ratified the treaty. On 27 February 2005: the FCTC has entered into force and has become an International law. Today the FCTC has 146 parties (16 April 2007)

  32. Taxes – tax and price measures are an important way of reducing tobacco consumption, particularly in young people, and requires signatories to consider public health objectives when implementing tax and price policies on tobacco products. Labelling – The text requires that at least 30 per cent of the display area on tobacco product packaging is taken up by clear health warnings in the form of text, pictures or a combination of the two. Packaging and labelling requirements also prohibit misleading language such as “light”, “mild” or “low tar”. Advertising –The final text requires parties to move towards a comprehensive ban within five years of the convention entering into force. Framework Convention on Tobacco Control (FCTC)

  33. Liability – Parties to the convention are encouraged to pursue legislative action to hold the tobacco industry liable for costs related to tobacco use. Financing – Parties are required to provide financial support to their national tobacco control programmes. A number of countries and development agencies, have already pledged their commitment to include tobacco control as a development priority. Other issues - The text also requires countries to promote treatment programmes to help people stop smoking and education to prevent people from starting, to prohibit sales of tobacco products to minors, and to limit public exposure to second-hand smoke. Framework Convention on Tobacco Control (FCTC)

  34. WHO/NHLBI WHO/ARIA 2001 1995 One of the first examples of worldwide used disease-specific guidelines and the 1st one on Asthma Project coordinators Nikolai Khaltaev (WHO) Claude Lenfant (NHLBI) Including adaptation to developing countries: EBM low drug cost affordable for most patients WHO essential list of drugs

  35. WHO/NHLBI 2001 The first worldwide used guidelines on COPD NHLBI/WHO Workshop Report: Global Strategy for the Diagnosis, Management, and Prevention of COPD. Scientific information and recommendations for COPD programs.

  36. Practical Approach to Lung health 2003 A primary health care strategy for a coordinated and standardized approach for an integrated management of the patient with respiratory symptoms in countries with epidemiological transition. Targets Improve diagnostic strategies, reduce inappropriate care, foster cost reduction strategies, savings in antibiotic usage and increase appropriate CS usage Tested in 15 different countries Source : WHO/STB

  37. WHO/MNC/CRA/03.2 STEP SuRF Prevention of Allergy and Allergic Asthma Based on the WHO/WAO Meeting on the Prevention of Allergy and Allergic Asthma Geneva,8-9 January 2002 FCTC

  38. A new way to prevent and control chronic respiratory diseases Global Alliance against Chronic Respiratory Diseases

  39. 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

  40. 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. What is the value added of this new way?

  41. Before GARD = lack of coordination, competition

  42. WHO calls for a global and coordinated effortto fight Chronic Respiratory Diseases

  43. 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

  44. 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

  45. "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" GARD Rosa Mota, former Portuguese marathon runner and Olympic champion

  46. A world where all people breathe freely GARD Vision

  47. GARD Goal and Objective • Goal • To reduce the global burden of chronic respiratory diseases • Objective • To 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.

  48. June 2004 Oct 2002 Jan 2003 Jan 2005 March 2007 GINA (P. O’Byrne, CAN) GOLD (L. Fabbri, ITA) ICC (L. Grouse, USA) INTERASMA (I. Ansotegui, SPA) IPCRG (A. Ostrem, UK) IPRAIS (J. Warner, UK) IUATLD (N. Billo, FRA) KAF (Y. Kim, KOR) KTL (P. Puska, FIN) NHLBI (B. Alving, USA) PSA (M. Kowalski, POL) RSP (A. Chuchalin, RUS) SIMER (G. D'Amato, ITA) SFAIC (G.Pauli, FRA) SPAIC (M. Morais de Almeida) SPLF (B. Housset, FRA) TTS (A. Kocabas, TUR) TNSACI (O. Kalayci, TUR) WAO (C. Baena-Cagnani, ARG) WHO-CC DU (S. Makino, JAP) WHO-CC GU (G. Joos, BEL) WONCA (A. Loh, SIN) WHO EFA ARIA WHO AAAAI AAAF ACAAI ARIA ATS EAACI EFA ERS FILHA FIRS GA2LEN GINA GOLD ICC INTERASMA KAF NHLBI WAO WHO-CC DU WHO-CC UCM WONCA WHO AAA (D. Vervloet, France) AAAAI (E. Simon, CAN) AAAF (R. Pawankar, JAP) ACAAI (M. Blaiss, USA) AIMAR (C. Donner, ITA) ALAT (C. Luna, ARG) ALLERG.O.S (P. Demoly, FRA) 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 R. Kauppinen, FIN) FIRS (A. Turnbull, SWI) GA2LEN (P. Van Cauwenberge, BEL) WHO ACAAI ALAT ARIA ATS EAACI EFA ERS FILHA FIRS GA2LEN GINA GOLD NHLBI WAO WHO-CC DU WHO EFA 2 3 15 21 45 Participants

  49. 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

  50. GARD focuses on the needs of countries and fosters country-specific initiatives tailored to local conditions. A global alliance working at country level

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