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C. James Hospedales Pan American/World Health Organization

GLOBAL BURDEN OF NCDs and HOW TO ADDRESS IT European Commission Conference on Global Health: Coherence in Response to Globalisation. C. James Hospedales Pan American/World Health Organization. Noncommunicable Diseases and Conditions Adult mortality rates (2004). Launched October 2008. 5.8 M.

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C. James Hospedales Pan American/World Health Organization

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  1. GLOBAL BURDEN OF NCDs and HOW TO ADDRESS ITEuropean CommissionConference on Global Health: Coherence in Response to Globalisation C. James Hospedales Pan American/World Health Organization

  2. Noncommunicable Diseases and ConditionsAdult mortality rates (2004) Launched October 2008

  3. 5.8 M 5.3 M 26.0 M(above the age of 60) 20.0 M 2.4 M 8.1 M 6.8 M 9.0 M (below the age of 60) 3.7 M 17.0 M 13.6M 18.0 M World Developing countries Low-income countries Magnitude Total number of deaths 60 million 50 million 40 million 30 million 20 million 10 million 0 Group III - Injuries Low-income countries Group II – Other deaths from noncommunicable diseases Group II – Premature deaths from noncommunicable diseases (below the age of 60), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions

  4. WHO projects that over the next 10 years, the largest increase in deaths from cardiovascular disease, cancer, respiratory disease and diabetes will occur in developing countries. Noncommunicable Diseases (2006-2015) (WHO, Chronic Disease Report, 2005)

  5. Underweight Unsafesex High blood pressure Tobacco Alcohol Unsafe water, S&H High cholesterol Indoor smoke from solid fuels IIron deficiency High BMI Zinc deficiency Low and middle income Low fruit and vegetables Vitamin A deficiency Physical inactivity Occupational injury risks Lead exposure Illicit drugs Unsafe health care injections Lack of contraception Childhood sexual abuse 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% Attributable DALYs (% total 1.44 billion) Noncommunicable Diseases and ConditionsGlobal burden of disease attributable top 20 risk factors (2002) World Health Report, 2002) High income

  6. Co-existence of children with malnutrition and mothers with overweight in same home Fuente: Garret, J, Ruel, Marie T. The coexistence of child undernutricion and maternal overweight

  7. Tobacco Tobacco use is a risk factor for six of the eight leading causes of death in the world (WHO World Health Statistics, 2008)

  8. How did we get here? • Low awareness public & policy makers of problem or what can be done, espec to change environment; vs. “individual responsibility” • Availability and affordability of real food, espec fruits and veg • Globalization food – highly processed; available; high fat, TFAs, sugar, salt • Massive advertising; special risk children • Trade and agriculture policies, e.g., insuff. use of tariff “policy space” • Fiscal policies, e.g., tobacco and alcohol taxes, pricing • Tobacco industry/control, advertising, smoke free spaces • Urbanisation, technology changes favor inactivity • Built environment favors cars not people; safety concerns • Schools stress academics > physical activity, few healthy food choices • Workplaces: “work-risks” vs. “life-risks” • Public health training emphasizes dated agenda, not HP/DP and NCDs • Access to quality health services: trained providers, info systems, self care

  9. Globalisation and Health THE MALADIES OF AFFLUENCE The Economist, August 11th 2007

  10. Cheap cars, traffic jams, global warming, hard to walk/exercise, stress

  11. Costs not sustainable • World Econ Forum Global Risk report 2010 • CDC: 2/3 of $2Trillion health care bill in USA • Diabetes alone estimated to cost >$65Billion in LAC/yr • Diabetes and HBP estimated to cost 5-8% of GDP in direct and indirect costs in Trinidad & Tobago, Barbados, Jamaica • Renal dialysis bill in El Salvador is half the main hospital budget; much due to diabetes, hypertension poorly managed

  12. EVIDENCE OF PREVENTABILITY In 23 low and middle income countries, which account for 80% NCD burden globally.. Measures to reduce salt intake by 15%, tobacco use by 20%, and scale up access to low cost treatment to 60% those at high risk could avert 31+ million deaths over 10 years and would cost on average $0.36 per person per year.. Lancet, December 2007 Special Issue on Chronic Diseases

  13. A clear roadmap for Member States, partners and WHO Six objectives: 1. Raising the priority accorded to noncommunicable diseases in development work at global and national levels, and integrating prevention and control of non-communicable diseases into policies across all government departments 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level

  14.  Raising the priority of NCDs in development work A/RES/64/265 • Decidesto convene a high-level meeting of the General Assembly in September 2011, with the participation of Heads of State and Government, on the prevention and control of non-communicable diseases; • Also decides to hold consultations on the scope, modalities, format and organization of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases, with a view to concluding consultations, preferably before the end of 2010; • EncouragesMember States to include in their discussions at the High-level Plenary Meeting of the sixty-fifth session of the General Assembly on the review of the Millennium Development Goals, to be held in September 2010, the rising incidence and the socio-economic impact of the high prevalence of non-communicable diseases worldwide; • Requeststhe Secretary-General to submit a report to the General Assembly at its sixty-fifth session in collaboration with Member States, the World Health Organization and the relevant funds, programmes and specialized agencies of the United Nations system, on the global status of non-communicable diseases, with a particular focus on the developmental challenges faced by developing countries.

  15.  Establishing national NCD policies and plans Strengthening health care for people with NCDs: • WHO technical support package of essential interventions to integrate NCD prevention and control into primary care • MoH driven NCD scale up of PHC using the technical and policy guidance of package in 10 countries.

  16.  Reducing NCD risk factors • Bangladesh • Brazil • China • Egypt • India • Indonesia • Mexico • Pakistan • Philippines • Russia • Thailand • Turkey • Ukraine • Vietnam • Uruguay Reducing the level of exposure of individuals and populations to tobacco use Technical assistance package to implement the WHO FCTC demand reduction measures • Monitoring (surveillance and evaluation) • Protect (second hand smoke) • Offer help • Warn against dangers • Enforce legislation against tobacco promotion • Raise taxes

  17.  Promoting NCD research WHO Advisory Committee on Health Research WHO Meeting on A Prioritized Research Agenda Geneva, 25-26 August 2008) Ministerial Forum on Research for Health, Bamako, 17-19 November 2008 Jan-July 2010: Consultations with international partners and development of the first public version October 2009: Second draft A Prioritized NCD Research Agenda

  18. Strengthening PartnershipsGlobal NCDnet 5 2009 International Advisory Council 2010 WHO Secretariat Funding Facility Global/Regional Partners Forum Partners Council Network (Virtual) Working Group 1 Working Group 2 Working Group 3 Working Group 4 Working Group n

  19. Regional Partners Forum for Action on Chronic Disease PUBLIC CARMEN Countries Sub regional movements CDC & NIH PHAC PAHO/WHO: Convener & Catalyst WEF, IBLF, PAHEF, PHAC CIVIL SOCIETY IAHF, IDF, UICC Consumers Int’l Churches & FBOs Academia Media Ciclovias EMBARQ 5-A-DAY RAFA PRIVATE FOOD & NON ALCO MEDIA & TELECOM PHARMACEUTICALS SPORTS & FITNESS INSURANCE AUTO/TRUCK Platform to engage public sector, businesses, civil society To take joint, innovative action at all levels

  20. Meeting of Private Sector Companies on TF elimination in PAHO, Washington

  21.  Surveillance, monitoring and evaluation

  22. Conclusions • NCDs: largest health burden in nearly all countries • Demographic change and risk factors • Interconnected to econ, social, environ issues • Impact on par with global fiscal crisis • Largely preventable through comprehensive prevention & control programs at reasonable cost • We have a plan • Requires political will, all-of-society approach partnerships, resources

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