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Non Communicable Diseases (NCDs)
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Dr. Nizam Uddin Ahmed• Faculty, PHD, North South University
• Email: [email protected]
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Outline
• Definition • Non-communicable disease mortality
worldwide• The Epidemiological Transition• Major risk factors• Infection and non-communicable diseases• Prevention & Control• Summary
Classifying deaths and diseases (WHO)
• Communicable diseases [Group I]– Those where death is directly due to the action of
a communicable agent• Non-communicable diseases
– Diseases [Group II]• Cancer, diseases of various organ systems (eg
respiratory, cardiovascular etc.), diabetes, mental health etc.
– External causes (injuries, poisonings and violence) [Group III]
What are NCDs?
• NCD is a medical condition or disease, which is not infectious
• NCDs are diseases or medical conditions with long duration and relatively slow progression
• NCDs are usually called “Chronic Diseases”
Why NCDs Are Important in Public Health?
• 65 million deaths that occurred globally in 2011
• 36 million – 63.2%, almost two thirds – were due to NCDs
• 9 million death that occurred among people under age 60
• mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases
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Public Health Agency of Canada | Agence de la santé publique du Canada 14
1Except in sub-Saharan Africa.
NCDs are an increasing global challenge…
Most significant cause of death (63%) worldwide1
Even in African nations, NCDs are rising rapidly, projected to exceed communicable, maternal/perinatal, and nutritional diseases as the most common causes of deaths by 2020
NCDs cause premature deaths under age 60:13% in high income countries
29% in low middle income countries
Source: World Health Organization (WHO).
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Public Health Agency of Canada | Agence de la santé publique du Canada 15
• NCDs represent a major fiscal and productivity risks for the economies of low, middle, and high income countries
• NCDs increase income inequities, deplete household wealth, increase health spending and lower labour productivity
• Most countries will not be able to address NCD challenge with medical care alone: Prevention is critical
…and their impacts extend beyond health.
Source: World Bank 2011.
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The epidemiologic transition(Omran, 1971)
Change in the balance of disease in a population
from communicable diseases
to non-communicable disease
Urbanisation
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Urbanisation
0
10
20
30
40
50
60
70
80
90
100
1950 1960 1970 1980 1990 2000 2010 2020 2030
Urb
an p
opul
atio
n as
% o
f tot
al
North AmericaLatin America & Caribbean
Europe
Oceania
Asia
Africa
WORLD
2007
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Drivers of the epidemiological transition in low and middle income countries• Population ageing• Major socio-economic changes (especially
urbanisation)– changes in risk factors such as diet, physical activity,
smoking etc.
Public HealthAgency of Canada
Agence de la santépublique du Canada
The Cost…
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Public Health Agency of Canada | Agence de la santé publique du Canada 23
…and NCD rates are increasing at 14 percent each year.
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using POHEM Model, Statistics Canada.
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Public Health Agency of Canada | Agence de la santé publique du Canada 24
COSTS
Individual Household Employer Government
Health care
Out of pocket drugs
Lost productivity
Disability
Economic burden of NCDs
…and so is our economy. NCDs cost $190 billion in 2010.
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Canada’s declining deaths from heart disease due in part to an increase in treatment.
Public Health Agency of Canada | Agence de la santé publique du Canada 25
Treating NCDs is costly.
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010; and CMAJ, July 7, 2009 - 1881 (1-2).
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 20060
20
40
60
80
100
120
140
0
1
2
3
4
5
6
Deaths
Expenditures
Years
Deaths per100,000 pop.
(sdr)
Expenditures on
cardiovascular disease
medication (Billion $)
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Public Health Agency of Canada | Agence de la santé publique du Canada 26
…but the economic impact goes beyond the health sector.
about twice the direct health care costs
Direct health care costs in 2010 = $68 billion
Indirect costs due to income and productivity losses = $122 billion estimated
Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from the Canadian Institute for Health Information and from the data of the Economic Burden of Illness in Canada,1986, 1993, 1998.
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Public HealthAgency of Canada
Agence de la santépublique du Canada
The Cost-effectiveness Options…
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Source: Global Status Report on Noncommunicable Diseases 2010, World Health Organization.
Public Health Agency of Canada | Agence de la santé publique du Canada 28
Metabo
lic
/ph
ysiol
ogica
l
risk f
actor
s
Unde
rlying
drive
rsBe
havio
ural
risk f
actor
s
NCDs
Raised blood pressureOverweight/obesity
Raised blood glucoseRaised lipids
Tobacco useUnhealthy diet
Physical inactivityHarmful use of alcohol
GlobalizationUrbanization
Population ageing
SocialDeterminantsof Health
We understand the pathway to NCDs...
Public Health Agency of Canada | Agence de la santé publique du Canada
80% of heart disease, diabetes and respiratory diseases and 40% of cancers are preventable by eliminating four common risk factors
NCDs
Common risk factors
Tobacco use
Unhealthydiets
Physicalinactivity
Harmful useof alcohol
Cardiovasculardiseases
Diabetes
Cancer
Respiratorydiseases Source: WHO, Raising the priority of non-communicable disease in development
work at global and national levels.
…and we know prevention is critical.
Public Health Agency of Canada | Agence de la santé publique du Canada
For every $1 invested in labelling on cigarette packages there is a saving of $52 for the Canadian economy including $8 for Government1
For Worksite Health Promotion, the Atlantic Health and Wellness Institute found that returns per dollar ranged from $1.64 to $3.98 based on employee risk factors after 3 months of intervention2
Intervention for prevention works...
Sources: 1Health Canada, 2011.2Spencer & Associates, 2002.
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Public Health Agency of Canada | Agence de la santé publique du Canada 31
Assessing results of nine prevention approaches, a study using OECD/WHO model predict both the per capita investment costs and their likely outcomes in improving population health.
Mainly, the study concluded the best return for the prevention dollar came from a combination of several interventions from public and private sector sources.
… and healthy promotion is everyone’s business.
Health Outcomes at the Population Level (average effects per year)
School-based interventions
Mass media campaigns
Food advertising self-regulation
Food labelling
Worksite interventions
Food advertising regulation
Physician counselling
Fiscal measures
Physician-dietician counselling
0 10,000 20,000 30,000 40,000
Disability-adjusted life years
Life years
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Public HealthAgency of Canada
Agence de la santépublique du Canada
The Macroeconomic options…
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Actions by many sectors have an impact on our lifestyles and health. NCDs
Agri-food
Work Places
Transport
Economic Development
Education
Income
Urban Planning
Environment and
Sustainable Development
Finance
Trade
Public HealthAgency of Canada
Agence de la santépublique du Canada
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Conclusions…
Summary• Non-communicable diseases are now the
most common cause of death world wide• Increasing rates in low and middle income
countries because of change in lifestyles (urbanisation)
• Key risk factors have very large effects• Interventions are effective and can reduce
burden• The need to combine results and have large
studies35
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Group Work• Group 1: What are causes of NCDs and how
to prevent and control? • Group 2: Why Hypertension and Diabetics
are increasing and how to prevent and control?
• Group 3: NCDs mortality is high, why major programs are not in place?
• Group 4: What are major strategies of NCDs prevention and control in Bangladesh?
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Acknowledgements
• I would like to acknowledge all references that are utilized for this presentation.