Global Alliance against Chronic Respiratory Diseases

1. Global Alliance against Chronic Respiratory Diseases 11th Annual Congress of the Turkish Thoracic Society 25 April 2008, Antalya By Alvaro A. Cruz, MD (NMH/CHP/CPM)

2. Chronic Diseases cause 60% of deaths 7% Preventing chronic diseases. A vital investment. WHO, 2005.

3. Chronic Respiratory Diseases (CRD) Everybody exposed to risk factors Over 1 billion people have CRD Four million deaths/year. Thirty eight people die of CRD every 5 minutes.

4. Chronic Diseases cause 60% of deaths 7% Preventing chronic diseases. A vital investment. WHO, 2005.

6. Global Alliance against Chronic Respiratory Diseases (GARD) • What is GARD? • GARD objectives and methods • GARD output and results

7. Global Alliance against Chronic Respiratory Diseases (GARD) • What is GARD? • GARD objectives and methods • GARD output and results

8. The epidemic of chronic respiratory diseases COPD global prevalence estimate • Pooled prevalence of 26 spirometry surveys: 9.2% (>40 years) • Halbert et al (systematic review). ERJ 2006; 28:523-32. • World population in 2007: 6.67 billion • World population prospects. The 2006 revision. United Nations, 2007. • % of world population older than 40 years: 34.5% • Age standardization of rates: a new WHO standard (www.who.int/healthinfo/paper31.pdf)

9. The epidemic of chronic respiratory diseases ISAAC Phase III n = 304.679 13 to 14 years 106 centres 56 countries Ascher et al. Lancet 2006; 368:733-43.

10. The epidemic of chronic respiratory diseases ISAAC Phase III n = 304.679 106 centres 56 countries Ascher et al. Lancet 2006; 368:733-43.

11. The cost of severe asthma Values in US dollars per year. Franco R. Manuscript in preparation.

12. What is GARD? • Recognized of the enormous suffering related to chronic respiratory disease • Requested to WHO Director General and Member States to take action to prevent and control • Suggested of global partnerships as effective means to mobilize resources In response to the World Health Assembly (193 Member States): GARD, an alliance of 78 national and international organizations, institutions and agencies

13. What is GARD? Oct 2002 Jan 2003 June 2004 Jan 2005 WHO EFA WHO EFA ARIA WHO ACAAI ALAT ARIA ATS EAACI EFA ERS FILHA FIRS GA2LEN GINA GOLD NHLBI WAO WHO-CC DU 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 2 3 15 21

14. GARD is WHO! • 4329 long term staff • 3968 temporary staff • From 152 nationalities - WHO Headquarters - 7 Regional Offices - 144 Country Offices

15. WHO NCD action plan: a proposal • Vision: a world free of preventable NCD, in which all people have access to appropriate care • Mission: lead and catalyse an intersectoral, multilevel response to address premature mortality and ill-health • Goal: to reduce global mortality due to NCD by 2% over current trends

16. WHO Action Plan for Chronic Diseases • Awareness and advocacy • Building capacity of national action plans • Interventions to reduce exposure to risk factors • Research to optimize prevention and control • Promotion of partnerships for prevention and control • Establishment of a global evaluation system Member States WHO partners

17. GARD collaboration in WHO • Practical Approach to Lung Health – HTM Cluster • Integrated Management of Adolescent and Adult Illness (IMAI) – HTM Cluster • Health Security and Environment • Information, Evidence and Research • Health Action in Crisis • Office of the Legal Counsel (DGO) • Partnership and UN Reform (DGO) • Tobacco Free Initiative – NMH Cluster • Chronic Diseases Prevention and Management

18. GARD Methods “Man’s goodness is a flame that can be hidden but never extinguished” Nelson Mandela

19. GARD Governance Structure Executive Committee General Meeting Plenary Management Planning Group Coordination Working Groups Country-Focus Group Advising Advising Secretariat (CRD/CPM/CHP/NMH)

20. Global Alliance against Chronic Respiratory Diseases (GARD) • What is GARD? • GARD objectives and methods • GARD output and results

21. Gaps of knowledge • How to stop progression of COPD? • More effective strategy for smoking cessation? • Primary prevention of asthma? • Effective strategy for indoor environmental control in asthma and rhinitis? Global surveillance, prevention and control of chronic respiratory diseases. WHO, 2007.

22. Asthma prevalence and mortality Masoli M et al, Allergy 2004.

23. Gaps of knowledge implementation • Lack of prevention • Insufficient access to early and proper diagnosis • Lack of access to primary care • Lack of access to referrals • Effective treatment unavailable or unaffordable

24. Goal, Purpose and Strategic Objectives To reduce the global burden of chronic respiratory diseases by a comprehensive approach at country level through national alliances • To build, maintain and monitor the alliance • To estimate the global need for prevention and care for CRD • To advocate for action against CRD • To assist countries to formulate and implement plans for prevention and control of CRD

25. Milestones for Evaluation of Performance

26. Building National Alliances for GARD • Interested parties may constitute a country alliance with the aim of pursuing GARD goal and objectives at the country level • GARD Country is part of the effort of GARD, but it is legallyindependent from GARD and from WHO • Example of logo:

27. Key Players for Building GARD Country • Ministry of Health: • GARD Country initiator consults the MOH about the proposal • If supportive, MoH designates a focal point for GARD Country • WHO (at all levels): • WHO HQ/GARD secretariat and WHO Country Office are informed • WHO HQ/GARD secretariat inform WHO Regional Office and Country Office • GARD • General Meeting is informed on the development of GARD Countries

28. Network for protection against chronic diseases private sector family and community health professionals government

29. Global Alliance against Chronic Respiratory Diseases (GARD) • What is GARD? • GARD objectives and methods • GARD output and results

30. Results - GARD Flyer English French Spanish Russian Chinese Arabic and Portuguese

31. www.who.int/gard

32. GARD Book • A landmark WHO publication edited by Bousquet & Khaltaev with support from GARD experts • Launch: Stockholm, 17 Sep 2007 • First print: 4 000 copies • Availability: PDF for download on GARD website and sales • Distribution to: all MoH, WHO Representatives, WHO Regional Offices, WHO Senior Officers, libraries • Translation: Portuguese

33. GARD General Meetings Global launch, China 2006 GARD General Meeting Korea launch, Seoul 2007 GARD General Meeting

34. GARD General Meeting Report GARD General Meeting Report (Seoul, 2007) • Published on GARD website in December 2007 • Prepared by co-rapporteurs A. Cruz and A. Yorgancioglu assisted by E. Minelli • Report on GARD current development from the secretariat and Planning Group • Reports on GARD in countries • Message of support from UN Under-Secretary-General • Statement of the Seoul General Meeting (available on GARD website)

35. More GARD publications GARD Basket • GARD basket • GARD framework for evaluation of chronic respiratory diseases • Adaptation and evaluation of guidelines • Asthma in Latin America

37. A demonstration project for the underprivileged • Research project in Salvador, Brazil (2.7 million inhab.) • Referral centres for severe asthma providing free medication • Patients: 2 385 (severe asthma), from Dec 2003 to Apr 2007 • Training primary care teams ProAR volunteer squad Franco et al. BMC Public Health 2007; 7:82.

38. Rapid reduction in asthma admissions following a public health intervention Souza-Machado et al. Manuscript in preparation.

39. Rapid reduction in asthma admissions following a public health intervention Souza-Machado et al. Manuscript in preparation.