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Noncommunicable Diseases: An Overview

Noncommunicable Diseases: An Overview. Dr Ala Alwan Assistant Director General World Health Organization. Scope. Noncommunicable diseases (NCDs): Cardiovascular diseases (e.g. heart diseases, stroke) Cancers Diabetes Chronic respiratory diseases (e.g. asthma)

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Noncommunicable Diseases: An Overview

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  1. Noncommunicable Diseases: An Overview Dr Ala Alwan Assistant Director General World Health Organization

  2. Scope Noncommunicable diseases (NCDs): • Cardiovascular diseases (e.g. heart diseases, stroke) • Cancers • Diabetes • Chronic respiratory diseases (e.g. asthma) Risk factors for noncommunicable diseases: • Tobacco use • Unhealthy diet • Physical inactivity • Harmful use of alcohol

  3. Topics • WHO Global Burden of Disease (2004 update published in October 2008) • WHO Global Health Risks (published in October 2009) • Further analysis on the burden of noncommunicable diseases based on the WHO Global Burden of Disease

  4. Distribution of age at death and numbers of global deaths (2004)

  5. Per cent distribution of age at death by WHO region (2004)

  6. Please download at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html

  7. The global magnitude of deaths from noncommunicable diseases (2004) 70 million 10% 60 million 5.8M 31% 35.0M 50 million 40 million 59% 30 million 20 million 18.0M Source: 10 million 0 Total number of deaths (2004) Group III - Injuries Low-income countries Group II – Deaths from noncommunicable diseases Group I – Communicable diseases, maternal, perinatal and nutritional conditions

  8. Global projections (2004 to 2030) Cancers 12 10 Ischaemic HD Stroke 8 Deaths (millions) 6 Acute respiratoryinfections 4 Road trafficaccidents Perinatal 2 HIV/AIDS TB Malaria 0 2000 2005 2010 2015 2020 2025 2030

  9. Global projections (2004 to 2030) 30 Intentional injuries Other unintentional 25 Road traffic accidents Other NCD 20 Cancers Deaths (millions) 15 CVD 10 Mat//peri/nutritional 5 Other infectious HIV, TB, malaria 0 2004 2015 2030 2004 2015 2030 2004 2015 2030 High-income countries Middle-income countries Low-income countries

  10. Distribution of deaths in the world by sex (2004)

  11. Distribution of deaths in the world by cause and sex (2004)

  12. Mortality rates among men and women aged 15–59 years (2004)

  13. Adult mortality rates (2004)

  14. Age-standardized DALYs for noncommunicable diseases (2004)

  15. Other non-communicable diseases Mental health conditions Diabetes Chronic respiratory diseases Cancers Cardiovascular diseases Breakdown of deaths from NCDs (2004) in the League of Arab States (oPT: no estimates available) 100% 80% 60% 40% 20% 0% Iraq UAE Syria Libya Qatar Egypt Oman Sudan Kuwait Jordan Algeria Yemen Tunisia Djibouti Bahrain Somalia Morocco Lebanon Comoros Mauritania Saudi Arabia High-income Middle-income Low-income Source: Global Burden of Disease 2004

  16. Please download at: http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html

  17. The 10 leading risk factor causes of death (2004)

  18. Key findings • High blood pressure is the leading risk factor for mortality, responsible for 13% of deaths globally • Low fruit and vegetable intake, lack of exercise, alcohol and tobacco use, high BMI, high cholesterol, high glucose, and high BP are responsible for more than half of the deaths due to heart disease • Tobacco is responsible for 5.1 million deaths. Almost 1 in 8 deaths of adults over the age of 30 is due to smoking • Being overweight or obese is the fifth leading risk for death, responsible for 7 per cent of deaths globally • Unsafe sex, which leads to transmission of human papillomavirus, is responsible for deaths due to cervical cancer. Cervical cancer is the leading cause of cancer death in Africa.

  19. % High blood pressure 12.8 Tobacco use 8.7 High blood glucose 5.8 Physical inactivity 5.5 Overweight and obesity 4.8 High cholesterol 4.5 Unsafe sex 4.0 Alcohol use 3.8 Childhood underweight 3.8 Indoor smoke from solid fuels 3.3 59 million total global deaths in 2004 % Childhood underweight 5.9 Unsafe sex 4.6 Alcohol use 4.5 Unsafe water, sanitation 4.2 High blood pressure 3.7 Tobacco use 3.7 Suboptimal breastfeeding 2.9 High blood glucose 2.7 Indoor smoke from solid fuels 2.7 Overweight and obesity 2.3 1.5 billion total global DALYs in 2004 Leading causes of attributable global mortality and burden of disease (2004) Attributable Mortality Attributable DALYs

  20. Deaths attributed to 19 leading factors (2004)

  21. Percentage of DALYs attributed to 19 leading risk factors (2004)

  22. Percentage of deaths over age 30 caused by tobacco (2004)

  23. Tobacco Rising production and consumption in developing countries

  24. Tobacco: The poor and uneducated are the ones who smoke the most Smoking prevalence in Bangladesh (1995) Source: Sen, B & Hulme D, 2004

  25. Overweight and obesity in people over 15 selected countries

  26. The global burden of non-communicable diseases (based on the 2004 update of the Global Burden of Disease)

  27. The global magnitude of deaths from noncommunicable diseases (2004) 70 million 10% 60 million 5.8M 31% 35.0M 50 million 40 million 59% 30 million 20 million 18.0M Source: 10 million 0 Total number of deaths (2004) Group III - Injuries Low-income countries Group II – Deaths from noncommunicable diseases Group I – Communicable diseases, maternal, perinatal and nutritional conditions

  28. Group III - Injuries Low-income countries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions The global magnitude of premature deaths from NCDs (2004) 70 million 10% 60 million 5.8M 31% 50 million 19.2M 40 million 32% 15.8M 30 million 20 million 18.0M Source: 27% 10 million 0 Total number of deaths (2004)

  29. Group III - Injuries Low-income countries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions The global magnitude of deaths from noncommunicable diseases (2004) 25 million 20 million 6.1M 15 million 10 million 6.0M Source: 1.9M 1.9M 0 High-income countries Upper middle-income Lower middle-income Low-income countries

  30. Deaths in Africa* (2004) Group III - Injuries Low-income countries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases (below the age of 60 (left) or 70 (right)) Group I – Communicable diseases, maternal, perinatal and nutritional conditions 14,000,000 7% 0.9 0.9 12,000,000 17% 1.4M 2.2M 10,000,000 2.2M(<70) 11%(<60) 1.4M (<60) 65% 8,000,000 8.1M 8.1M Lower margin 6,000,000 7% 11% 4,000,000 17%(<70) Source: 2,000,000 65% 0 Upper margin Lower margin Upper margin * Data set includes AFRO Member States, as well as Djibouti, Egypt, Libya, Morocco, Somalia, Sudan and Tunisia

  31. Group III - Injuries Low-income countries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases (below the age of 70), which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions The magnitude in 144 low- and middle-income countries 60 million 10% 50 million 5.3 M 34% 28% 40 million 14.2 M 30 million 14.0 M 28% 20 million 17.4 M Omitted from the MDGs: 14.0 million premature deaths from non-communicable diseases Source: 10 million Total number of deaths in low- and middle-income countries (2004)

  32. The magnitude in 144 low- and middle-income countries 18,000,000 16,000,000 14,000,000 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 Africa Americas Middle-East Europe South-East Asia Western Pacific Group III - Injuries Group II – Other deaths from non-communicable diseases Group II – Premature deaths from non-communicable diseases, which are preventable Group I – Communicable diseases, maternal, perinatal and nutritional conditions

  33. Breakdown of deaths from non-communicable diseases 6% 6% 4% 3% 3% 3% 12% 13% 50% 49% 27% 25% All countries Low- and middle-income countries Cardiovascular diseases Cancers Respiratory diseases Diabetes Mental health conditions Other NCDs

  34. Low- and middle-income countries which are most affected 70% of the global burden of premature deaths from NCDs(22 countries) • Afghanistan • Bangladesh • Brazil • China • DR Congo • Egypt • Ethiopia • India • Indonesia • Iran • Mexico • Myanmar • Nigeria • Pakistan • Philippines • Russian Federation • South Africa • Thailand • Turkey • Sudan • Ukraine • Vietnam

  35. Prevalence of obesity, ages 30+ (2004) male female South-East Asia Western Pacific Africa Eastern-Mediterranean Europe Americas 10% 30% 20% 0% 10% 20% 30% Source:

  36. SEA 3% 6% West Pac 9% 9% Africa 5% 13% 12% 30% Eastern-Med Europe 21% 29% Prevalence of obesity, ages 30+ (2015) Americas 32% 46% male female

  37. What will happen if nothing is done now? Projections of estimated deaths from noncommunicable diseases (millions) Source:

  38. What will happen if nothing is done now? Death from noncommunicable diseases Increases (in percentage and millions) in 2015 vs 2004 30% 2.5M 25% 2.0M 20% 1.5M 15% 1.0M Source: 10% 0.5M 5% 0% 0 Africa Americas Eastern Med Europe South- East Asia Western Pacific Africa Americas Eastern Med Europe South- East Asia Western Pacific

  39. WHO report on Women and Health (launched on 9 November 2009) 10 leading causes of deaths in females (2004) http://www.who.int/gender/women_health_report/en/index.html

  40. Download at: http://www.diabetesatlas.org

  41. Diabetes in the world at a glance

  42. Top-10 number of people with diabetes (20-79 years) (2010 and 2030)

  43. Top-10 prevalence (%) of diabetes(20-79 years) (2010 and 2030)-IDF Atlas

  44. Prevalence (%) estimates of diabetes (20-79 years) (2010) –IDF Atlas

  45. Prevalence (%) estimates of diabetes (20-79 years) (2030)

  46. Macro-economic impact Oil and gas price spike Retrenchment from globalization Asset price collapse NCDs Fiscal crisis Flu pandemic World Economic Forum: Global Risk Assessment 2009 Food crisis http://www.weforum.org/pdf/globalrisk/globalrisks09/global_risks_2009.pdf Infectious disease

  47. Why low- and middle-income countries are disproportionally affected

  48. Socio-economic impact at household level Poverty at household level Populations in low- and middle-income countries Increased exposure to common modifiable risk factors: Unhealthy diets Physical inactivity Tobacco use Harmful use of alcohol Globalization Urbanization Population ageing Non-communicable diseases: Cardiovascular diseases Cancers Diabetes Chronic respiratory diseases Loss of household income from unhealthy behaviours Loss of household income from poor physical status Limited access to effective and equitable health-care services which respond to the needs of people with non-communicable diseases 14 million people die prematurely each year in developing countries from non-communicable diseases Loss of household income from high cost of health care

  49. The poorest people in developing countries are often affected the most The cost of caring for a family member with diabetes can be more than 20 per cent of low-income household incomes in developing countries The cost per year of diabetes care at household level

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