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Chronic diseases worldwide

Giovanni Viegi CNR Institute of Clinical Physiology, Pisa, Italy 2006-07 ERS Past President on behalf of Nikolai Khaltaev, MD, PhD Chronic Diseases and Health Promotion, WHO, Geneva (CH).

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Chronic diseases worldwide

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  1. Giovanni ViegiCNR Institute of Clinical Physiology, Pisa, Italy2006-07 ERS Past Presidenton behalf ofNikolai Khaltaev, MD, PhD Chronic Diseases and Health Promotion, WHO, Geneva (CH) The World Health Organization (WHO): the Global Alliance against Chronic Respiratory Diseases (GARD) project in Respiratory Medicine Roma, 15 novembre 2006

  2. Chronic diseases worldwide • Cardiovascular diseases mainly heart disease and stroke • Cancer • Chronic respiratory diseases • Diabetes

  3. Chronic diseases in Spain In Spain, chronic diseases are projected to account for 90% of all deaths

  4. Chronic Respiratory Diseases including 300 million people with asthma, Hundreds of millions of people have chronic respiratory diseases, • 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.

  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. CHRONIC RESPIRATORY DISEASES AFFECT WOMEN AND MEN ALMOST EQUALLY 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

  7. The global epidemic of chronic respiratory diseases 4 000 000PEOPLE DIED FROMCHRONIC RESPIRATORY DISEASES IN 2005

  8. 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

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

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

  11. Burden of COPD • 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

  12. 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

  13. 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

  14. The estimated DALYs* for COPD according to the population of each WHO region for the year 2005 Source: WHO, Evidence and Information Policy, 2005 *DALYs = Disability Affected Life Years

  15. Prevalence of COPD in Europe

  16. 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 Number of Disability-Adjusted Life Years (000s) 0 5000 10000 15000 20000

  17. WHO global approach to control Chronic Respiratory Diseases

  18. 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 140 parties (16 November 2006)

  19. 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

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

  21. 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

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

  23. Before GARD = lack of coordination, competition

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

  25. 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

  26. 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

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

  28. GARD contribution to prevent and control chronic diseases

  29. GARD Vision A world where all people breathe freely

  30. GARD Goal and Objective • Goal • To improve global lung health • 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.

  31. June 2004 February 2006 Oct 2002 Jan 2003 Jan 2005 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) 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 (M. Nieminen, FIN) FIRS (A. Turnbull, SWI) GA2LEN (P. Van Cauwenberge, BEL) GINA (P. O’Byrne, CAN) GOLD (L. Fabbri, ITA) ICC (L. Grouse, USA) INTERASMA (I. Ansotegui, SPA) IPRAIS (J. Warner, UK) IPCRG (A. Ostrem, UK) IRCCS-SR (S. Bonini, ITA) WHO ACAAI ALAT ARIA ATS EAACI EFA ERS FILHA FIRS GA2LEN GINA GOLD NHLBI WAO WHO-CC DU WHO EFA IUATLD (N. Billo, FRA) KAF (Y. Kim, KOR) KTL (P. Puska, FIN) NHLBI (B. Alving, USA) RSP (A. Chuchalin, RUS) SFAIC (G.Pauli, FRA) SPAIC (M. Morais de Almeida) SPLF (B. Housset, FRA) TTS (A. Kocabas, TUR) WAO (C. Baena-Cagnani, ARG) WHO-CC DU (S. Makino, JAP) WHO-CC GU (G. Joos, BEL) WONCA (A. Loh, SIN) 2 3 41 15 21 GARD Participants from European Region

  32. 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

  33. GARD will contribute to the global goal • A 2% annual reduction in chronic disease death rates worldwide, per year, over the next 10 years to 2015. • The scientific knowledge to achieve this goal already exists.

  34. 9 out of 10 lives saved: low and middle income countries

  35. Economic gain: billions

  36. GARD Working Groups: Estimate population needs and advocate WG.1- Burden, risk factors and surveillance (G Viegi, S Buist, Y Fukuchi) WG.2- Awareness and advocacy (C Lenfant, A Turnbull, P van Cauwenberge)

  37. GARD Working Groups: Formulate and adopt policy WG.3- Prevention and health promotion (M Boland, A Custovic) WG.4- Diagnosis of CRD and allergy (K Rabe, S Wenzel) WG.5- Control of CRD and allergies, Availability and affordability of drugs (J Bousquet, E Bateman, L Fabbri, C van Weel) WG.6- Pediatric asthma (C Baena-Cagnani, E Mantzouranis, FER Simons, E Valovirta)

  38. GARD governance WHO: administrative secretariat Leader: N.Khaltaev Steering Committee: GARD administrative leader; GARD chair; GARD co-chair Advisory Committee: in total 15 persons *GARD administrative leader; GARD chair; GARD co-chair *6 persons from scientific organisations, defined One person from each of the following member categories: *International governmental organizations *Nongovernmental organizations *National government - developed country *National government - developing country *Foundations *Academies and research institutes Executive Committee (n=15) Scientific Committee Work group chairs Chairs of National GARD Committee

  39. Towards a Global Alliance against Chronic Respiratory Diseases at Country Level

  40. Desired outcome at country level: initiated or upgraded CRD surveillance, prevention and control programme in the country GARD - country HOW? Approach: building an Alliance against Chronic Respiratory Diseases at country level

  41. What are the necessary conditions that have to be in place in order to pursue the idea of developing a GARD-Country? • The basics of CRD surveillance, prevention and control programme are already in place in the country. If this is not true, the commitment to initiate a CRD programme shall be evident in the country. • The Ministry of Health of the country explicitly requests help to WHO and its partners for the development of an upgraded plan for surveillance, prevention and control of CRD

  42. What are the steps to develop a GARD – Country? 1. Is there the need for a Global Alliance against Chronic Respiratory Diseases at country level to upgrade the CRD surveillance, prevention and control programme? This is a strategic alliance Between organizations drawn from the different sector of societies(government, business, NGOs) Who commit to work collaboratively towards the common goal to improve lung health In which all partners contribute from their core expertise Share risks And benefits by achieving their own, each others, and the overall goal of the alliance. What is the value added? Do the benefits outweigh the risks associated?

  43. Value Added GARD – Country shall act as a coordination and creation of a momentum that invites new inputs from various stakeholders, in order to become a true national response to the need of initiating/upgrading the National CRD Programme. • It shall focus on what single partners cannot achieve alone: • Coordinating already existing activities related to CRD • Exchanging sound and relevant information • Raising greater awareness on CRD and their risk factors as well as on how to prevent and treat them • Generating political commitment at country level • Raising additional resources

  44. What are the steps to develop a GARD – Country? (cont.) • GARD Country Coordinator • Making an inventory of stakeholders • Approaching other partners • Exploratory workshop • Terms of Reference • Structure • Don't forget to review your work from time to time

  45. Patients' Associations Professional Societies Universities National NGOs involved in community-based interventions Ministry of Health GARD Focal Point Hospitals International NGOs involved in community-based interventions WHO GARD - Country GARD - Country Coordinator Secretariat Planning Group Bilateral cooperative agencies General Meeting Multilateral cooperative agencies Private sector representatives

  46. www.who.int/respiratory/gard

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