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GARD

GARD. Global Alliance against Chronic Respiratory Diseases WHO J Bousquet, R Dahl, N Khaltaev, HJ Bekedam. www.who.int/chp. GARD Launch Press Conference. N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in China S Hurd (USA): The burden of CRD

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GARD

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  1. GARD Global Alliance against Chronic Respiratory Diseases WHO J Bousquet, R Dahl, N Khaltaev, HJ Bekedam

  2. www.who.int/chp

  3. GARD Launch Press Conference N Zhong (China): Chronic respiratory diseases (CRD) are a major burden in China S Hurd (USA): The burden of CRD N Khaltaev (WHO): From the fragmented CRD programs to GARD J Bousquet (France): The GARD action plan M Boland (Ireland): Health promotion and CRD prevention J Walsh (USA): The patient’s expectations

  4. Suzanne S. Hurd - USA The burden of CRD

  5. Chronic Respiratory Diseases: An Increasing Global Public Health Problem • The World Health Organization estimates that over 1 billion people suffer from chronic respiratory diseases worldwide • Prevalence and severity are increasing globally • Cause substantial socioeconomic burden to individuals and societies • In all countries, chronic respiratory diseases are: • Under recognized • Under diagnosed • Under treated

  6. Chronic Respiratory Diseases (CRD)

  7. 7% Global Distribution – Chronic Disease Mortality: All ages, 2005 > 4,000,000 Communicable diseases; Maternal/perinatal, Nutritional deficiencies Cardiovascular Cancer Chronic Respiratory Diseases (CRD) Diabetes Other Chronic Diseases Injuries Source: Preventing Chronic Diseases, a vital investment, WHO, 2005

  8. Increasing Burden of Diseases and Injuries: Change in Rank Order of DALYs* 1999 2020 • Acute lower respiratory • infections • 2. HIV/AIDS • 3. Perinatal conditions • 4. Diarrhoeal diseases • 5. Unipolar major depression • 6. Ischemic heart disease • 7. Cerebrovascular disease • 8. Malaria • 9. Road traffic injuries • 10. COPD • 11. Congenital abnormalities • 12. Tuberculosis 1.Ischemic heart disease 2. Unipolar major depression 3. Road traffic injuries 4. Cerebrovascular disease 5. COPD 6. Acute lower respiratory infections 7. Tuberculosis 8. War 9. Diarrhoeal diseases 10. HIV ……. 15. Trachea, bronchus, lung cancers *DALY = Disability-adjusted life year Source: WHO Evidence, Information and Policy, 2000

  9. Chronic Respiratory Diseases (CRD) Global Prevalence Asthma > 300 million Allergic rhinitis > 400 million Chronic obstructive > 80 million moderate pulmonary disease to severe COPD; many millions with mild COPD

  10. Burden of Asthma • Asthma is one of the most common chronic diseases in the world • Prevalence ranges from 1% to 18% • An estimated 250,000 deaths annually, many of them preventable • Direct costs (hospital, medications) account for 1-3% of total medical expenses in most countries

  11. Affordability of Asthma DrugsModerate persistent asthma, 1998 Cost in US$ N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3: 268-271

  12. Burden of COPD • COPD is a major cause of morbidity, mortality and disability • High prevalence, morbidity and mortality of COPD present challenges for healthcare systems • Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form

  13. COPD Mortality by Gender, USA, 1980-2000 Number Deaths x 1000 Year Source: Mannino D, US CDC, August 2002

  14. Cigarette Smoke Environmental tobacco smoke Fumes/gases Indoor/outdoor pollution Occupational dusts Risk Factors for COPD Nutrition Socio-economic status Infections

  15. Chronic Respiratory Diseases are a Global Public Health Problem

  16. N Khaltaev - WHO From the fragmented CRD programs to GARD

  17. WHA resolution 53.17 The 53rd World Health Assembly • recognized the enormous human suffering caused by chronic respiratory diseases (CRDs) • and requested the WHO Director General to continue giving priority to the prevention and control of CRDs • with special emphasis on developing countries and other deprived populations WHA resolution 53.17, May 2000 endorsed by all 191 WHO Member States

  18. WHO calls for a global and coordinated effort to fight chronic respiratory diseases GARD

  19. GARD • The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary alliance of organizations, institutions, and agencies working towards a common vision to improve global lung health according to the local needs. • Vision: A world where all people can breathe freely: Breath for all.

  20. Fragmented success stories • Asthma and COPD plans: • Brasil • China • Finland • France • Portugal • USA

  21. Experience from Brazil • In Brazil since 2002 the ministry of health provides free pharmaceutical assistance for severe asthmatics. • In the province of Salvador this lead to the reduction of 55% of hospital submissions. The mean annual income of families of severe asthmatics increased by 10 %. • The public health system has saved 566 US$ per patient per year.

  22. Increase awareness on asthma (patients and public) Improve management of acute severe asthma follow-up of asthmatics diagnosis and management of childhood asthma in schools Increase patient education Better manage and prevent occupational asthma Surveillance of asthma and risk factors A Success Story: France

  23. Healthcare benefits from asthma intervention 350 Reimbursement asthma Hospitalization days Death rate 300 250 200 Asthma Indices (base 100 in 1981) 150 100 50 0 1981 1983 1985 1987 1989 1991 1993 1995 Year Haahtela et al, Thorax 1998

  24. J Bousquet - France The GARD Action Plan

  25. Specific Objectives of GARD • Build a stepwise and integrated program of prevention and control of CRD. • Improve collaboration between the fragmented WHO and non-WHO programs. • Increase awareness of CRD. • Reduce the burden of CRD, and foster country-specific initiatives appropriate to local needs. • Focus on developing countries and deprived populations.

  26. Specific Objectives of GARD • Availability and affordability of medications • Provide appropriate training for health care personnel. • Provide education to patients, care givers and families.

  27. Comprehensive and integrated action is the means to prevent and control chronic diseases

  28. 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)

  29. 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)

  30. Identify Policy Implementation Steps • The GARD action plan should be applied at the country level. • A national coordination group will: • Provide existing national statistics on CRD • Assess the specific needs for the given country • Review the GARD action plan • Determine the relevant issues for the country action plan • Develop a country-specific action plan

  31. M Boland - Ireland Health promotion and CRD prevention

  32. Health promotion and disease prevention Key messages: • Everyone has the right to live in a clean air environment • Environmental exposure to unhealthy environment causes incurable COPD, asthma, cardiovascular disease and cancer • Complete elimination is the only way to remove the risk • This applies to tobacco smoke and all other at risk environments

  33. WG.3- Health promotion and disease prevention Goals: • Help all countries to build and implement policies to reduce the burden of • tobacco smoke, • indoor and outdoor pollution, • occupational hazards • and other risk factors of relevance for CRD

  34. WG.3- Health promotion and disease prevention Some WHO programs are already available: • FCTC (Framework Convention on Tobacco Control) • Healthy Environment for Children Alliance • WHO program on prevention of allergy and asthma • Environment • Occupational diseases

  35. ‘Slan’ Surveys OTC/MRBI Tracker Smoking Ban No. of Smokers fallen by 25% Tobacco Cessation

  36. WG.3- Health promotion and disease prevention • Biomass fuels • Over 2 billion people in the developing world burn traditional biomass fuels indoor for cooking and heating. • Resulting in an estimated 1.6 million deaths each year, largely among women and children. • Acute respiratory infections and COPD (700,000 deaths/yr)

  37. J Walsh - USA The patient’s expectations

  38. Personal History of J. Walsh • When did the disease start • Symptoms • Effects on daily life • Treatment • Expectations • Future

  39. Patient’s Expectations from GARD • Health care professionals should be able to recognize CRD at an early phase and introduce early management • The patient must be taken more seriously about his/her symptoms • Health care systems should be structured to manage patients with chronic disease, including regular and long term follow up ….continued

  40. Patient’s Expectations from GARD (continued) • Health care systems should develop a structured patient education, information and training programs • General public should become more informed of CRDs problems and take a more positive attitude toward the needs of CRD patients • Societies should be more receptive to the value of environmental changes

  41. Doctors and Patients must be Partners in Care of CRDs.

  42. Conclusions • Hundreds of millions of people suffer from chronic respiratory diseases • Over 4 million people die prematurely each year • Huge economic burden • In all countries, and particularly in developing countries • In all age groups • Prevalence and mortality are increasing

  43. www.who.int/chp

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