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KAUNAS UNIVERSITY OF MEDICINE FACULTY OF PUBLIC HEALTH DEPARTMENT OF PREVENTIVE MEDICINE

KAUNAS UNIVERSITY OF MEDICINE FACULTY OF PUBLIC HEALTH DEPARTMENT OF PREVENTIVE MEDICINE. “INTERNATIONAL HEALTH: NONCOMUNICABLE DISEASES AS GLOBAL HEALTH PROBLEM”. PROF. Vilius GRABAUSKAS. FROM BISPH TRAINING COURSE PUBLIC HEALTH SCIENCE. LEARNING OBJECTIVES.

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KAUNAS UNIVERSITY OF MEDICINE FACULTY OF PUBLIC HEALTH DEPARTMENT OF PREVENTIVE MEDICINE

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  1. KAUNAS UNIVERSITY OF MEDICINE FACULTY OF PUBLIC HEALTH DEPARTMENT OF PREVENTIVE MEDICINE “INTERNATIONAL HEALTH: NONCOMUNICABLE DISEASES AS GLOBAL HEALTH PROBLEM” PROF. Vilius GRABAUSKAS FROM BISPH TRAINING COURSE PUBLIC HEALTH SCIENCE

  2. LEARNING OBJECTIVES • TO UNDERSTAND THE TRANSITION IN GLOBAL HEALTH • TO UNDERSTAND THE CAUSES OF THE ABOVE TRANSITION • TO UNDERSTAND WHO’s POLICY AND STRATEGIES TO COMBAT THE EPIDEMICS OF NONCOMMUNICABLE DISEASES Vilius GRABAUSKAS

  3. THE WORLD HEALTH IS IN TRANSITION EPIDEMIOLOGICAL : NCDS OVERRIDING INFECTIOUS DISEASES AND DOUBLE BURDEN OF DISEASES IN MANY DEVELOPING COUNTRIES LIFESTYLES: TOBACCO USE IS INCREASING DIETS ARE RAPIDLY CHANGING PHYSICAL ACTIVITY REDUCES ALCOHOL USE INCREASES, OBESITY, DIABETES, HYPERTENSION ARE INCREASING IN MOST PARTS OF THE WORLD,WHILE UNDER-NUTRITION REMAINS A SEVERE ISSUE DEMOGRAPHIC : POPULATION AGEING. GLOBALIZATION : INCREASING GLOBAL INFLUENCES Vilius GRABAUSKAS

  4. THE GLOBAL NCD REALITY • NONCOMMUNICABLE DISEASE CONTRIBUTE 60 % OF DEATHS AND 43 % OF THE GLOBAL BURDEN OF DISEASE. ALREADY 79% OF THESE NCDS ARE OCCURRING IN DEVELOPING COUNTRIES. • BY 2020 THESE DEATHS WILL ACCOUNT FOR 73% DEATHS AND 60% OF THE DISEASE BURDEN. • HALF OF THESE DEATHS ARE ATTRIBUTABLE TO CARDIOVASCULAR DISEASES. • THERE ARE MORE CVD DEATHS IN INDIA OR CHINA THAN IN ALL DEVELOPED COUNTRIES ADDED TOGETHER. Vilius GRABAUSKAS

  5. WORLD, DEATHS, BY BROAD CAUSE GROUP, 2001 Total deaths: 56,554,000 Noncommunicable conditions (33.1 million) Communicable diseases, maternal and perinatal conditions and nutritional deficiencies (18.4 million) Injuries (5.1 million) Source: WHR 2002 ViliusGRABAUSKAS

  6. WORLD, DALY’s, BY BROAD CAUSE GROUP, 2001 Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Injuries Source: WHR 2002 Vilius GRABAUSKAS

  7. DEATHS, BY BROAD CAUSE GROUP AND WHO REGION, 2001 Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Noncommunicable conditions Injuries 75% 50% 25% AFR AMR EMR EUR SEAR WPR Source: WHR 2002 Vilius GRABAUSKAS

  8. DALY’s, BY BROAD CAUSE GROUP AND WHO REGION, 2001 Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Injuries 75% 50% 25% AFR AMR EMR EUR SEAR WPR Source: WHR 2002 Vilius GRABAUSKAS

  9. WORLD, DISTRIBUTION OF CAUSES OF DEATH, 2001 Total deaths: 56,554,000 Other NCDs Respiratory infections Respiratory diseases Neuropsychiatric disorders HIV/AIDS Digestive diseases Perinatal conditions Malignant neoplasms Diarrhoeal diseases Tuberculosis Childhood diseases Diabetes Malaria Maternal conditions Nutritional deficiencies Other CD causes Injuries Cardiovascular diseases Source: WHR 2002 Vilius GRABAUSKAS

  10. WORLD DISEASE BURDEN (DALY’s), 2001 Maternal conditions Perinatal conditions Nutritional deficiencies Respiratory infections Other NCDs Malaria Malignant neoplasms Childhood diseases Diabetes Diarrhoeal diseases Neuropsychiatric disorders HIV/AIDS Tuberculosis Other CD causes Sense organ disorders Cardiovascular diseases Injuries Congenital abnormalities Respiratory diseases Digestive diseases Musculoskeletal diseases Diseases of the genitourinary system Source: WHR 2002 Vilius GRABAUSKAS

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  12. NCD’s ARE TO A GREAT EXTEND PREVENTABLE • KEY RISK FACTORS: UNHEALTHY DIET (SALTY, FATTY AND SUGARY FOOD), PHYSICAL INACTIVITY, TOBACCO AND ALCOHOL DRINKING. • THE BEHAVIOURAL FACTORS LEAD TO HIGH BLOOD PRESSURE & HYPERTENSION, BLOOD GLUCOSE INTOLERANCE & DIABETES, ELEVATED BLOOD CHOLESTEROL & HYPERCHOLESTEROL, ANAEMIA, OVERWEIGHT AND OBESITY. • SIMPLE CHANGES IN THESE LIFESTYLES CAN POWERFULLY PREVENT CHRONIC DISEASES AND PROMOTE HEALTH. • SOME OF THE CHANGES TAKE PLACE RELATIVELY QUICKLY AND ALSO IN LATE AGE. Vilius GRABAUSKAS

  13. WHAT PREVENTS EFFECTIVE NCD ACTION? • MYTHS ABOUT NCDs: diseases of affluence, of ageing, of men • UNDERESTIMATION OF PREVENTION IMPACT • MYTH OF CONG DELAY IN PRENTION EFFECT • LOW PUBLIC VISIBILITY (Perceived threat) • LACK OF DIRECT ECONOMIC INTERESTS (vs drugs or clinical measures) • CONFLICTING MESSAGES, often related to commercial interests • INERTIA IN CHANCE: administration, financing, services etc Vilius GRABAUSKAS

  14. WHO RESPONSE • EVIDENCE BASE, ADVOCACY, SURVEILLANCE, TRAINING • NATIONAL PROGRAMMES AND POLICIES • REGIONAL ACTIVITIES : WHO REGIONAL OFFICES AND REGIONAL NETWORKS • GLOBAL ACTION: PARTNERSHIP, ATTENTION TO GLOBAL ASPECTS (MARKETING, TRADE, COMMUNICATION ETC) • SURVEILLANCE AND MONITORING Vilius GRABAUSKAS

  15. WHO RESPONSE WHO’S GLOBAL STRATEGY FOR NCD PREVENTION AND CONTROL (WORLD HEALTH ASSEMBLY 2000) • NCDS A PRIORITY • PREVENTION KEY • INTEGRATED PREVENTION • TARGETS MAIN COMMON RISK FACTORS - TOBACCO - UNHEALTHY DIET - PHYSICAL INACTIVITY Vilius GRABAUSKAS

  16. HEALTHY LIFESTYLES • FOR INDIVIDUAL: • EFFECTIVE WAY TO • PREVENT DISEASES AND PROMOTE HEALTH • FOR THE SOCIETY: • A COST EFFECTIVE AND SUSTAINABLE WAY • TO IMPROVE PUBLIC HEALTH Vilius GRABAUSKAS

  17. STRATEGIES TO REDUCE RISK:WORLD HEALTH REPORT 2002 MESSAGES • VERY SUBSTANTIAL HEALTH GAINS CAN BE MADE FOR RELATIVELY MODEST EXPENDITURES ON INTERVENTIONS • CHANGING POPULATION DISTRIBUTIONS OF RISK FACTORS (LIKE BLOOD PRESSURE, BLOOD CHOLESTEROL) THROUGH GENERAL LIFESTYLE CHANGES • CVD: POPULATION WIDE STRATEGIES TO LOWER CHOLESTEROL (QUALITY OF FAT) AND BLOOD PRESSURE (SALT REDUCTION) KEY • TOBACCO: HIGHER TAXES, COMPREHENSIVE ADVERTISEMENT BAN • MIX OF POPULATION WIDE, HIGH RISK AND SECONDARY PREVENTION MEASURES, IN A COST EFFECTIVE BALANCE • SUSTAINED POLICY ACTION • STRENGTHENING OF NATIONAL INSTITUTIONS TO IMPLEMENT AND EVALUATE RISK REDUCTION PROGRAMMES Vilius GRABAUSKAS

  18. NCD PREVENTION AND HEALTH PROMOTION NETWORKS GLOBAL INTEGRATED NCD PREVENTION NETWORKS CINDI EUROPEAN NETWORK IN 27 COUNTRIES CARMEN LATIN AMERICAN NETWORK IN 8 COUNTRIES INITIATIVE IN EASTERN EMAN MEDITERRANEAN REGION NANDI INITIATIVE IN THE AFRICAN REGION (SEARO) SOUTH EAST REGION: PLANS ARE UNDER WAY (WPRO) WESTERN PACIFIC REGION : PLANS ARE UNDER WAY MEGA COUNTRY HEALTH PROMOTION NETWORK: 11 COUNTRIES; OVER 100 MIL. PEOPLE Vilius GRABAUSKAS

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