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Time to Act

Time to Act. The Wold Heart Federation Advocacy Toolkit. Content. The background -a look at the current NCDs and CVD situation Behind CVD -the risk factors CVD and NCDs -a neglected development issue We can act -the World Heart Federation’s and the world’s global response.

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Time to Act

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  1. Time to Act The Wold Heart Federation Advocacy Toolkit

  2. Content • The background-a look at the current NCDs and CVD situation • Behind CVD-the risk factors • CVD and NCDs-a neglected development issue • We can act-the World Heart Federation’s and the world’s global response

  3. The background A look at the current NCDs and CVD situation « NCDs are ranked as the third most likely risk to come true and the fourth most severe in its impact for 2009 » The World Economic Forum

  4. Global Burden of Disease: NCDs cause over 50% of deaths worldwide Source: WHO Global Burden of Disease Report Update 2004, Geneva 2008 Note: NCDs: CVD, cancer, chronic respiratory, diabetes

  5. Global Burden of Disease: NCDs responsible for high rates of premature mortality (deaths per 1000 in adults between 15-59 years) Source: WHO Global Burden of Disease Report Update 2004, Geneva 2008

  6. NCDs: Leading cause of male deaths worldwide WHO region Projected main causes of death in males by WHO region, all ages, 2005 Age-standardized death rates per 100,000 Source : «Preventing Chronic Diseases: A Vital Investment», WHO, 2005

  7. NCDs: Leading cause of female deaths worldwide WHO region Projected main causes of death in females by WHO region, all ages, 2005 Age-standardized death rates per 100,000 Source : «Preventing Chronic Diseases: A Vital Investment», WHO, 2005

  8. Among NCDs, CVD is leading cause of death worldwide Estimated global deaths by cause, all ages, 2005 Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»

  9. Burden of CVDMen and women by region Number of CVD deaths in millions Source: WHO Country Profiles, 2002, www.who.int

  10. A higher % of CVD deaths occur between 35 and 64 years of age in countries with developing economies Source : “A Race Against Time”, The Earth Institute, Colombia University, Stephen Leeder, 2004

  11. Disease burden of CVD and NCDs falls heavily on those between the ages of 15 & 69 in low- and middle-income countries (2005 figures) DALY (Disability Adjusted Life Year)= The sum of years of potential life lost due to prematuremortality and the years of productive life lost due to disability. Source : “Public Policy and the Challenge of Chronic Noncommunicable Diseases”, World Bank, 2007

  12. « The NCDs epidemic threathens to overwhelm health systems » WHO, ECOSOC meeting 2009 « The costs of NCDS create a poverty trap (…) The epidemic of NCDs slows economic growth » WHO, ECOSOC meeting 2009 There is a « bitter irony in promoting health as a poverty reduction strategy at a time when the costs of health care themselves can be a cause of poverty » Her Royal Highness Princess Muna Al-Hussein, Ecosoc Meeting 2009

  13. NCDs macro-economic impactLost National Income WHO: "Heart disease, stroke and diabetes alone are estimated to reduce GDP between 1 to 5% per year in developing countries experiencing rapid economic growth" Source: WHO Chronic Disease Report, 2005

  14. « In Oman, it is estimated that there will be a 210% increase in the demand for health care by 2025, and treatment for cardiovascular diseases alone will account for 21% of total health care expenditures » WHO, ECOSOC Meeting 2009 « Conservatives estimates in Brazil, China, India, Mexico, and South Africa indicate that each year at leat 21 million years of future productive life are lost because of CVD » WHO, ECOSOC Meeting 2009

  15. CVD macro-economic impact • CVD is expensive for the world. It costs the European Union US$ 219 billion (€169 billion). The most updated data from USA shows that CVD costs nearly US$ 403 billion in direct and indirect costs • By comparison, the estimated cost of all cancers is US$ 189 billion (€146.19 billion) and HIV US$ 28 billion (€22.4 billion) • The economic burden is no longer confined to the affluent, industrial world • In developing countries CVD disproportionately affect the working-age adults from lower socio-economic groups • In 1995, the costs of tobacco-related disease accounted for 1.5% of GDP in China, and obesity-related costs were equivalent to 1.1% of the GDP Source: WHO, Hu & Mao, 2002; Leeder et. Al. 2004

  16. NCDs: ProjectionsDeath trends (2006-2015) (WHO Chronic Disease Report, 2005) 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.

  17. NCDs: ProjectionsProjected Deaths in 2015 and 2030 Intentional injuries Other unintentional Road traffic accidents Other NCD Cancers CVD CVD Mat//peri/nutritional Other infectious HIV, TB, malaria

  18. CVD: Projections • Contact WHO

  19. Behind CVDThe risk factors « Multiple studies confirm the rise of NCDs and risk factors around the world. But the rise in risk factors is only partly explained by a change in personal behaviours. Personal behaviours are not only a personal choice. Much larger forces are at play here » WHO, ECOSOC Meeting, July 2009

  20. NCDs: Risk factors4 Diseases, 4 Modifiable Shared Risk Factors

  21. NCDs: Risk factors’ impactTobacco: Behaviours associated with risk factors are costly Monthly household expenditure of tobacco vs. nutritious food among street children in Mumbai (India) 200 186.1 173.9 180 160 137.4 140 119 109.8 120 100 Avg. Monthly Exp in INR 80 61.9 60 48.5 43.6 40 20 0 Eggs Bidi Milk Fruits Gutkha Cigarettes Paan with tobacco Mutton/ Chicken/ Beef Items Consumed Source: Path Canada 2003

  22. CVD: Risk factors 6 of top 10 risk factors in low- and middle- income countries lead to CVD Risk factor for CVD Source : “Global Burden of Disease and Risk Factors”, Lopez and others, Oxford University Press, 2006

  23. CVD: Risk factorsProjected progression of hypertension Number of adults living with hypertension in millions Source: International Society of Hypertension

  24. CVD: Risk factors Trends in Hypertension More than 20 million people have hypertension in Africa, with a prevalence ranging from 25% to 35% in adults aged 25-64 years* In China, 18.8% above 18 of the population suffers from high blood pressure** In England, 32.1 % of people above 16 suffer from high blood pressure***, and 2 out of 3 people above 65 suffer from it as well**** *WHO Regional Office for Africa (WHO/AFRO), The Health of the People: The African Regional Health Report (2006). WHO Geneva 2006 **WHO Global Infobase, 2002 data for China ***WHO Global Infobase, 2003 data for England ****NHS, Health Survey for England, 2005

  25. CVD: Risk factorsTrends in Tobacco 20.4% of Australian women 26.2% of men above 18 and smoke* In France, 26.5 % of women and 33.3% of men between 12 and 75 are current users of tobacco** In Chile, 43.6% of males and 31.8% of females above 15 are current users of cigarettes*** In Indonesia, 63.5% of males are daily users of tobacco**** *,**,***,**** WHO Global InfoBase, countries surveys from various years

  26. CVD: Risk factorsTobacco use on the rise in developing countries

  27. « When money is tight, the first thing that drop out of the diet are usually healthy foods, like fruits, vegetables, and lean sources of protein, which are nearly always more expensive. Processed foods (…) become the cheapest way to fill a hungry stomach. This is the type of diet linked to the rise of chronic diseases. » Dr. Margaret Chan, ECOSOC Meeting, July 2009

  28. CVD: Risk factors: Trends in Obesity Worldwide, 30% of women and 40% of men are now overweight and 27% of women and 24% of men are obese* In China, 18.8% of women and 19.1% of men above 18 are overweight or obese** In South Africa, 56.2% of women 29.1% of men above 15 and are overweight or obese*** In the US, 31.1 % of males and 33.2% of females above 20 are obese**** In 2007, an estimated 22 million children under the age of 5 years were overweight throughout the world***** More than 75% of overweight and obese children live in low- and middle-income countries****** * Balkau B, et al. A Study of Waist Circumference, Cardiovascular Disease, and Diabetes Mellitus in 168 000 Primary Care Patients in 63 Countries. Circulation, 2007;116:1942-1951 **,***,****,***** WHO Global InfoBase, countries surveys from various years *****; ******WHO http://www.who.int/dietphysicalactivity/childhood/en/

  29. CVD: Risk factorsChildhood obesity trends around the world

  30. CVD: Risk factorsProjected prevalence of overweight and obese school children by region today and in 2010 46.4% 41.7% 38.2% 27.2% 27.7% 25.5% 23.5% 22.9% 12% 10.6% Source: Wang Y, Lobstein T, Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity. 2006; 1:11-25

  31. CVD and NCDs:A neglected development issue « Non-communicable diseases are responsible for twice the number of deaths caused by infectious diseases yet receive only a tiny fraction of national and development heath funding » Cherie Blair, ECOSOC Meeting, July 2009 « There does not seem to be a consensus among development agencies on the need to include non-communicable diseases (…) in global discussions on development » Dr.Ala Alwan, ECOSOC Meeting, July 2009 « The greatest burden of preventable death and disability in both rich and poor countries is being caused by the very conditions that are receiving least Official Development Assistance » Her Royal Highness Princess Muna Al-Hussein, ECOSOC Meeting, July 2009

  32. NCDsDonors are not responding to requests for technical assistance Official Development Assistance for Health (2006, in US$ Billions, total is US$21 billion) * ODA = Official Development Assistance provided by 24 OECD/DAC donor countries, as well as the EC

  33. Worldwide, current investement in CVD and other chronic diseases is outrageoulsy low… • The Global Fund for HIV/AIDS, TB and Malaria total pledges paid to date: USD 11.8 billion • Since 2000, the World Bank has so far made available nearly US$ 1.2 billion to fund HIV/AIDS programmes in Africa • In 2006, the International Finance Facility for Immunization launched a bond that raised US$ 1 billion • Total contributions to GAVI for the year 2007 amounted to US$ 786 million • Half of the US$ 1.8 billion allocated to health programmes by USAID in 2003 were for HIV/AIDS and infectious diseases. Another 45% were for maternal health, child survival and population control. • For the 2008-2009 biennum, the WHO will allocate almost US$ 900 million to communicable disease whereas the budget allocated to non-communicable disease barely reaches US$ 160 million.

  34. …but progress is being made slowly • Despite the apparent imbalance in the WHO budget, the funding for non-communicable disease for the 2008-2009 biennium represents a 44% increase from the 2006-2007 budget • It now represents 4% of WHO total budget (total budget is roughly US$ 3.3 billion) • Tobacco control, one of CVD main risk factors, is getting more and more funds: the Bloomberg initiative had an endowment of US$ 125 million, directed at low- and middle-income countries. US$ 250 million have recently been added to this pledge • The Bill and Melinda Gates Foundation is now getting involved in tobacco control, by pledging US$ 125 million • The Alliance for a Healthier Generation (USA) has so far received US$ 28 million from the Robert Johnson Foundation for its Healthy Schools programme • Ovations is contributing US$ 15 million to create centres to counter chronic disease in developing countries • The UK Medical Research Council supports the OxHA Grand Challenges in Chronic Non-Communicable Disease with a £6 million grant • In 2007, IDF received a multi-year grant of US$ 10 million for it BRIDGES programme which provides grants to fund translational research projects in diabetes prevention

  35. « We must make the prevention and control of non-communicable diseases and improvement of maternal health top priorities of the development agenda (…). Both are begging for more attention » Dr. Margaret Chan, ECOSOC Meeting, July 2009 « I want to highlight the glaring omission of non-communicable diseases in the MDGs (…). This anomaly should be corrected » Dr. Leslie Ramsammy, ECOSOC Meeting, July 2009

  36. A neglected development issue: CVD and NCDs are not included in the United Nations Millennium Development Goals Eradicate poverty and hunger Achieve primary universal education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Develop a global partnership for development Cardiovascular and other chronic diseases must be included

  37. We can actThe world’s and the World Heart Federation’s global response « We know the major steps that need to be taken to reverse this tidal wave of non-communicable diseases » Cherie Blair,ECOSOC Meeting, July 2009 « Control of non-communicable disease (is a) fully ready and mature area for efficient interventions with a huge return » Margaret Chan, ECOSOC Meeting, July 2009

  38. NCDs:The Global Response: example at the WHO level

  39. Increase tax rates for tobacco products Enact and enforce completely smoke-free environments Make tobacco cessation advice available as part of primary health care Require effective package warning labels Enact and enforce legislation to ban any form of direct and indirect tobacco advertising, promotion and sponsorship Obtain free media coverage of anti-tobacco activities Implement counter-tobacco advertising Strengthen tax administration to reduce illicit trade in tobacco products For more information please refer to the Framework Convention on Tobacco Control NCDs: Fighting risk factorsSelectedMulti-sectoral Approaches to Reduce Tobacco Use

  40. Reduce trans fatty acids and salt Restrict availability of energy dense foods and high calorie non-alcoholic beverages Increase availability of healthier foods including fruits and vegetables Practice of responsible marketing to reduce impact of unhealthy foods to children Make healthy options available and affordable Provide simple, clear and consistent food labels that are consumer friendly Reshape industry to introduce new products with better nutritional value For more information please refer to the Global Strategy on Diet Physical Activity and Health NCDs: Fighting risk factorsSelectedMulti-sectoral Approaches to Reduce Unhealthy Diet

  41. CVD: The World Heart Federation’s answer Together with its members, the WHF achieves its mission through: Awareness Building Advocacy Demonstration Projects Sharing Science/Building Capacity

  42. CVD: World Heart Federation’s Activities Applied Research Sharing Science Advocacy Awareness Building Building capacity

  43. CVD:Working with members to fight the disease 195 165 WHF’s membership in 2002 and today

  44. CVD:Working with members to fight the disease WHF’s membership by region in 2002 and today

  45. CVD:Working with members to fight the disease Member National Societies Algerian Society of Cardiology Argentine Society of Cardiology The Cardiac Society of Australia & New Zealand Austrian Society of Cardiology Bangladesh Cardiac Society Belarusian Scientific Society of Cardiologists Belgian Society of Cardiology Bolivian Society of Cardiology Association of Cardiologists of Bosnia & Herzegovina Brazilian Society of Cardiology Bulgarian Society of Cardiology Canadian Cardiovascular Society Chilean Society of Cardiology & Cardiovascular Surgery Chinese Society of Cardiology Colombian Society of Cardiology Croatian Cardiac Society Cuban Society of Cardiology Cyprus Society of Cardiology Czech Society of Cardiology Danish Society of Cardiology Dominican Society of Cardiology Ecuadorian Society of Cardiology Egyptian Society of Cardiology Society of Cardiology of El Salvador Finnish Cardiac Society French Society of Cardiology Georgian Association of Cardiology German Cardiac Society Ghana Society of Hypertension and Cardiology Hellenic Cardiological Society Guatemala Association of Cardiology Honduras Society of Cardiology Hong Kong College of Cardiology Hungarian Society of Cardiology Cardiological Society of India Indonesian Heart Association Iranian Heart Association Iraqi Cardio-Thoracic Society Irish Cardiac Society Israel Heart Society Italian Federation of Cardiology Japanese Circulation Society Jordan Cardiac Society Association of Cardiologists of Kazakhstan Kenya Cardiac Society The Korean Society of Circulation Association of Doctors of Internal Medicine of Kyrgyz Republic Latvian Society of Cardiology Lebanese Society of Cardiology and Cardiac Surgery Libyan Cardiac Society Lithuanian Society of Cardiology Macau Association of Cardiology Macedonia Society of Cardiology National Heart Association of Malaysia Mexican Society of Cardiology Moldavian Society of Cardiology Moroccan Society of Cardiology Cardiac Society of Myanmar Medical Association Cardiac Society of Nepal The Netherlands Society of Cardiology Nicaraguan Society of Cardiology Nigerian Cardiac Society Norwegian Society of Cardiology Pakistan Cardiac Society Society of Cardiology of Panama Paraguayan Society of Cardiology Peruvian Society of Cardiology Philippine Heart Association Polish Cardiac Society Portuguese Society of Cardiology Puerto Rican Society of Cardiology Romanian Society of Cardiology Society of Cardiology of the Russian Federation San Marino Society of Cardiology Saudi Heart Association Society of Cardiology of Serbia and Montenegro Singapore Cardiac Society Slovak Society of Cardiology Slovenian Society of Cardiology The South African Heart Association Spanish Society of Cardiology Sri Lanka Heart Association Swedish Society of Cardiology Swiss Society of Cardiology Syrian Cardiovascular Association Taiwan Society of Cardiology The Heart Association of Thailand Turkish Society of Cardiology Ukrainian Society of Cardiology Emirates Cardiac Society British Cardiovascular Society American College of Cardiology Uruguayan Society of Cardiology Venezuelan Society of Cardiology Vietnam National Heart Association

  46. CVD:Working with members to fight the disease Member National Heart Foundations Argentine Heart Foundation National Heart Foundation of Australia Austrian Heart Foundation National Heart Foundation of Bangladesh Heart Foundation of Barbados Belgian Heart League Foundation of Health and Heart (Bosnia and Herzegovina) Brazilian Heart Foundation (FUNCOR) Heart And Stroke Foundation of Canada Chilean Heart Foundation Un Coeur pour la Vie (Congo Brazzaville) Cyprus Heart Foundation Healthy Nutrition Forum (Czech Republic) Danish Heart Foundation Dominican Heart Foundation Ecuadorian Foundation of Cardiology Estonian Heart Association Finnish Heart Association Georgian Heart Foundation German Heart Foundation Ghanaian Heart Foundation Hellenic Heart Foundation (Greece) Hong Kong Heart Foundation Hungarian National Heart Foundation Icelandic Heart Association Seychelles Heart and Stroke Foundation Singapore Heart Foundation Slovak League Heart to Heart Slovenian Heart Foundation Heart and Stroke Foundation South Africa Spanish Heart Foundation Swedish Heart Lung Foundation Swiss Heart Foundation Taiwan Heart Foundation The Heart Foundation of Thailand Turkish Heart Foundation British Heart Foundation American Heart Association Venezuelan Heart Foundation All India Heart Foundation Heart Foundation of Indonesia Irish Heart Foundation Italian Heart Foundation The Heart Foundation of Jamaica Japan Heart Foundation Kenya Heart Foundation Kuwait Heart Foundation Lithuanian Heart Association Macau Heart Foundation The Heart Foundation of Malaysia Mauritius Heart Foundation Nepal Heart Foundation Netherlands Heart Foundation The National Heart Foundation of New Zealand Nigerian Heart Foundation Norwegian Council On Cardiovascular Disease Pakistan Heart Foundation Cardiological Foundation of Panama National Heart Foundation of Papua New Guinea Paraguayan Heart Foundation Heart Foundation of the Philippines Portuguese Heart Foundation Foundation for Cardiac Assistance (Romania) Serbian Heart Foundation

  47. CVD:Leveraging Partnerships International Organizations NGOs/Not for Profit Associations Corporate Partners/Major Sponsors

  48. Quote by WHF

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