WHO’S STRATEGY
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WHO’S STRATEGY PREVENTION & CONTROL of CHRONIC RESPIRATORY DISEASES Dr Nikolai Khaltaev MD, PhD Dept. of Noncommunicable Diseases Management World Health Organization Geneva, Switzerland. Summary. Burden of Respiratory Diseases. Contributing factors. Goals & Objectives of the WHO strategy.

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Summary

WHO’S STRATEGYPREVENTION & CONTROL ofCHRONIC RESPIRATORY DISEASESDr Nikolai Khaltaev MD, PhDDept. of Noncommunicable Diseases ManagementWorld Health OrganizationGeneva, Switzerland


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

source: World Health Report 2000


Summary

Five leading causes of death by the year 2020


Summary

Respiratory diseases in developing countries

communicable

tbc, pneumoina, etc.

%

%

changes in:

demographics, HCSs

schooling, income,

tobacco

XXth

XXIth

non-communicable

asthma, COPD, lung cancer


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

tobacco smoke

COPD

indoor pollution

CRD

outdoor pollution

occupation

malnutrition

Asthma

low birth weight

multiple early lung infections

CONTRIBUTING FACTORS (1)

LC

atopy

hygiene

+ indoor

allergens


Summary

CONTRIBUTING FACTORS (2)

socioeconomic factors:

POVERTY

rising trend

type of

occupation

level of

education

other priorities

level of

nutrition

no attention

type of

housing

environmental

determinants

no action

trend rising further

prevalence & severity

poor access to

health care


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

Goal of the strategy

to support Member States

in their efforts to reduce :

MORBIDITY

COPD

CRD

DISABILITY

LC

MORTALITY

Asthma


Summary

1. map the magnitude of CRD

2. analyse CRD determinants

(esp. poor, disadvanteged)

3. monitor future trends

Global Strategy

NCD Prevention & Control

OBJECTIVES OF THE STRATEGY

surveillance

tobacco smoke

indoor pollution

outdoor pollution

occupation

malnutrition

low birth weight

primary

prevention

multiple early lung infections

reduce exposure

of individuals

& populations to RFs

secondary & tertiary prevention

1. identifying cost-effective interventions

2. upgrading standards of care

3. upgrading accessibility of care

(at different levels of the HCS)


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

5. GENERAL PRINCIPLES

prevention &

control

programmes

implementation

of P&C

programmes

BARRIERS

measures

1. Strengthening

partnerships

4. Initiating cost-effectiveness studies

secondary prevention

risk factors reduction

Gov.

NGOs

INT. INSTs

EPAs

Industry

Schools

tobacco smoke

extending the capacity of

health care professionals

beyond the traditional focus on

acute care of communicable

respiratory diseases

indoor pollution

outdoor pollution

HCS

occupation

malnutrition

low birth weight

multiple early lung infections

5. Adapting the existing guidelines for the P&T

of CRDto the needs of developing countries

and to their primary health care level through

the use of the syndromic approach, if feasible

2. Developing globally

accepted criteria for

the diagnosis of CRDs

6. Improving access

of HCS to equipment & supplies

3. Integrating CRD prevention

into a comprehensive NCD

prevention programme

of patients to essential drugs

of patients to prevention trough care providers


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

STRATEGIC DIRECTIONS

standardize

epidemiological

methods

1. quantify and track CRD

2. to improve comparability

across member states

surveillance

develop uniform

set of diagnostic

criteria/tools

National

surveillance systems

monitoring quality of health care

1. availability, cost and quality of drugs

2. existence of local guidelines & policies

3. level of training of health professionals

developing & implementing simple methodologies for providing objectives measures of trends

1. cause specific mortality

2. risk factor prevalence

3. morbidity data:

a. hospital admissions

b. hospital consultations

c. therapeutic trends

Standard indicators:

1. lung function measurements

2. disease progression

3. absenteeism from school/work

4. hospitalizations


Summary

STRATEGIC DIRECTIONS (2)

primary prevention

reduction or avoidance of personal exposure to primary risk factorsto be started during pregnancy and childhood

tobacco smoke

low birth weight

poor nutrition

multiple early res. infections

indoor pollution

outdoor pollution

occupational risk factors

other 3

NCD pgms

information to the population about

HEALTHY LIFESTYLE:

1. healthy nutritional habits

2. regular exercise

3. avoidance of: tobacco

irritants

allergens

other sectors of the

community must

be actively engaged

more research is needed before effective strategies for primary prevention of asthma can be established


Summary

STRATEGIC DIRECTIONS (3)

secondary & tertiary prevention

early detection of occupational asthma

early detection of COPD

prevention of COPD

1. prevention of

further progression

2. cost-effective

managment

cost-effectiveness to be still fully evaluated

1. smoking cessation

2. pulmonary rehabilitation

3. reduction exposure irritants

4. influenza vaccination

1. reduction of symptoms

2. improvement of QoL

3. increase physical fitness

1. avoidance of allergens

2. avoidance of triggers

secondary & tertiary

prevention of asthma

primary prevention

of COPD & reduction of mortality

optimal pharmacological treatment

(including anti-.inflammatory medication)


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

PRIORITIES FOR WHO

Development and evaluation of reproducible and inexpensive methodologies to monitor COPD, suitable in developing countries

Identifying and addressing barriers to drugs and essential device accessibility

Developing approaches to improve accessibility to essential drugs in low income countries, designing and implementing a study of CRD drug and device availability and pricing in low and middle income countries

Identifying gaps in existing guidelines, utilizing EBM, considering cost-effectiveness and feasibility in developing countries, using guidelines as the rational basis for inclusion of drugs into the Essential Drugs List

Strenghtening research on primary & secondary prevention intervention of CRD

Identifying research priorities for prevention strategies, therapeutic regimens, alternative drug delivery systems, traditional medicine, alternative therapeutic approaches

Establishment and promotion of partnerships with professional, scientific, and educational institutions to promote and implement the initiative


Summary

Summary

Burden of Respiratory Diseases

Contributing factors

Goals & Objectives of the WHO strategy

General principles

Strategic directions

Priorities for WHO

Role of member states


Summary

ROLE OF MEMBER STATES

Development National Programmes for Prevention and Control of CRDs

Comprehensiveness: covering Surveillance, Prevention, Management

Integrating primary prevention of CRD with other NCDs (CVDs, diabetes, and certain cancers

Involve public and private health systems

Establish a connection between Health Care providers and Schools about dangers of tobacco smokes and the importance of minimizing LRI

Ensure the involvement of all levels of Health care providers, universities, patients, patients support groups, third party payers, and NGOs

provide proper training and continuing education and prevention and management of CRD

promote and implement research for better understanding of molecular and cellular pathogenic mechanisms of CRD

implement mechanisms for promoting access to basic drugs and adherence

to long-term therapy particularly for poor and disadvantaged people

include a rigorous method of evaluation and audit of health systems to ensure implementation and to test local effectiveness


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