slide1
Download
Skip this Video
Download Presentation
photo: US EPA

Loading in 2 Seconds...

play fullscreen
1 / 44

photo: US EPA - PowerPoint PPT Presentation


  • 113 Views
  • Uploaded on

The Global Alliance against CRD GARD: rationale and objectives of a novel WHO initiative Nikolai Khaltaev, MD Chronic Respiratory Diseases Team World Health Organization Geneva, Switzerland. 8 th Annual Congress of the Turkish Thoracic Society April, 2005. photo: US EPA. OUTLINE.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' photo: US EPA' - micol


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

The Global Alliance against CRD

GARD: rationale and objectives

of a novel WHO initiative

Nikolai Khaltaev, MD

Chronic Respiratory Diseases TeamWorld Health OrganizationGeneva, Switzerland

8th Annual Congress of the Turkish Thoracic Society

April, 2005

photo: US EPA

slide2

OUTLINE

1. WHO and its mandate

2. CRD, a public health priority for the WHA

3. GARD: an ambitious idea

4. GARD: programs against CRD

5. Present status of GARD

slide4

6 Regional Offices

192 Countries with

>75 WHO Representatives

slide5

WHO is a UN

specialized

Agency which is

controlled by the

Countries and

is serving the

Countries

192 countries

=

192 Ministries of Health

WORLD HEALTH ASSEMBLY

(annual mtg on May in Geneva)

WHO

deliver to countries

slide6

WHO CORE FUNCTIONS

  • Articulate policy & advocacy
  • Manage information (knowledge)
  • Provide technical & policy support to countries
  • Develop national & global partnerships
  • Develop norms & standards
  • Stimulate development of new technologies, tools and guidelines
slide7

OUTLINE

1. WHO and its mandate

2. CRD, a public health priority for the WHA

3. GARD: an ambitious idea

4. GARD: programs against CRD

5. Present status of GARD

slide8

Respiratory diseases in MIC & Transition Countries

communicable

tbc, pneumoina, etc.

%

%

changes in:

demographics, HCSs

schooling, income,

tobacco

XXth

XXIth

non-communicable

asthma, COPD, lung cancer

slide9

Burden of Major Respiratory Conditions

Condition

Deaths

DALYs

%

%

Lower Respiratory Infections

6.6 5.8

COPD

4.8 1.9

Tuberculosis

2.8 2.4

Lung/

Bronchus

/Trachea Cancer

2.2 0.8

Asthma

0.41.0

Total

16.8 11.9

source: World Health Report 2003

slide10

Increasing burden of noncommunicable diseases and injuries

change in rank order of DALYs for the 15 leading causes

(baseline scenario)

1999

2020

1.Acute lower respiratory infections

2. HIV/AIDS

3. Perinatal conditions

4. Diarrhoeal diseases

5. Unipolar major depression

6. Ischaemic heart disease

7. Cerebrovascular disease

8. Malaria

9. Road traffic injuries

10. COPD

11. Congenital abnormalities

12. Tuberculosis

13. Falls

14. Measles

15. Anaemias

1. Ischaemic heart disease

2. Unipolar major depression

3. Road traffic injuries

4. Cerebrovascular disease

5. COPD

6. Lower respiratory infections

7. Tuberculosis

8. War

9. Diarrhoeal diseases

10. HIV

11. Perinatal conditions

12. Violence

13. Congenital abnormalities

14. Self-inflicted injuries

15. Trachea, bronchus and lung cancers

DALY = Disability-adjusted life year

Source: WHO

Evidence, Information and Policy, 2000

slide12

epidemiological transition

=

rise of life expectancy

IF

in the absence of reduction

of exposure to smoke,

occupational hazards,

indoor & outdoor pollution

=

Rise of COPD

e.g.: 45 to 65

Behavioral &

Environmental

Risk Factors

COPD

slide13

because of epidemiological transition

the generation(s) exposed to

pneumonia & TB & malnutrition

in infancy-adolescence

but

surviving more

will develop

more COPD than the previous and

the next generation(s)

COPD

slide14

DALYs

Disability

Adjusted

Life

Years

One DALY: one lost year of “healthy” life

DALY = YLD + YLL

COPD

onset

expected

death

death

55

65

75

age (years)

YLD

YLL

50

Years of Life

with Disability

Years of Life Lost

slide16

COPD - Deaths / 1000

year 2000

<6.2

6.2-9.7

.

9.7-15.7

15.7-18.1

18.1-19.9

19.9-22.1

22.1-35.5

35.5-38.1

>38.1

no data

burden of copd by region
Burden of COPD by Region

WHO

region

SES

stratum

% Deaths

% DALYs

AFRO

1.1

0.3

D

1.1

0.3

E

AMRO

5.2

3.7

A

3.3

1.7

B

1.8

1.1

D

EMRO

2.1

1.4

B

2.3

0.9

D

EURO

3.6

3.4

A

2.4

1.8

B

2.0

1.7

C

SEARO

4.6

2.3

B

source:

World Health Report

2003

4.5

1.9

D

WPRO

1.9

2.5

A

12.6

4.0

B

Total

4.8

1.9

slide19

Trends of Asthma Prevalence in Europe

20

England

Asthma epidemic

has already

broken all the frontiers

on a global scale

This process

is part of

Westernization

and

is typical of the

"epidemiological transition"

England

15

Finland

France

10

%

Norway

Scotland

5

Sweden

Wales

0

1955

1965

1975

1985

1995

Trends of asthma prevalence outside Europe

20

Australia

Canada

-

Hong

Kong

Israel

15

Japan

New Zealand

New Zealand

%

10

Papua New Guinea

Singapore

Tahiti

5

Taiwan

United States

United States

Vietnam

0

1955

1965

1975

1985

1995

Matricardi et al. AAAI 2001

slide20

ASTHMA

ISAAC

most High-income

countries

most Low-Middle

income countries

slide21

in 2020 most cases of

“inner-city asthma”

will affect poor children

in megalopolises of

developing countries

westernization

+

urbanization

+

poverty

=

inner-city asthma

slide22

The enormous human suffering caused by

chronic respiratory diseases (CRD) has been recognised by the

53rd World Health Assembly (May 2000)

which requested the Director General

"to coordinate, in collaboration

with the international community,

global partnershipsand alliances "

for prevention and control of non-communicable diseases, including CRD (resolution WHA 53.17).

slide23

OUTLINE

1. WHO and its mandate

2. CRD, a public health priority for the WHA

3. GARD: an ambitious idea

4. GARD: programs against CRD

5. Present status of GARD

slide24

GLOBAL PARTNERSHIPS hosted by WHO

WHO role ?

coordination

link with countries

monitoring quality

slide26

WHO calls for a global and coordinated effort

to fight chronic respiratory diseases

GARD

slide27

GARD

Target:

to Develop and Implement

a National Plan against CRD

slide29

OUTLINE

1. WHO and its mandate

2. CRD, a public health priority for the WHA

3. GARD: an ambitious idea

4. GARD: programs against CRD

5. Present status of GARD

slide30

WHO/ARIA

Including adaptation to developing countries: EBM

low drug cost affordable for most patients

WHO essential list of drugs.

2001

WHO/NHLBI

One of the first examples of worldwide used

disease-specific guidelines

and the 1st one on Asthma

Project coordinators

1995 edition

Nikolai Khaltaev (WHO)

Claude Lenfant (NHLBI)

1995

Source : WHO/PMM

slide31

WHO/NHLBI

The first worldwide

used guidelines

on COPD

NHLBI/WHO Workshop Report:

Global Strategy for the Diagnosis, Management, and Prevention of COPD. Scientific information and recommendations for COPD programs.

2001

slide32

Practical

Approach to

Lung health

A primary health care strategy for a coordinated and standardized approach

for an integrated management of the patient with respiratory symptoms in countries with epidemiologica transition.

Targets

Improve diagnostic strategies,

reduce inappropriate care,

foster cost reduction strategies,

savings in antibiotic usage,

increase appropriate CS usage

Tested in 12 different countries

2003

Source : WHO/STB

BUT

poor economic conditions require

an integrated approach

at primary health care level

slide33

Practical Approach to Lung health

PAL

A primary health care strategy

for a holistic approach and an integrated management

of the patient with respiratory symptoms

in countries with epidemiological transition.

started in Morocco, Chile, South Africa, Nepal

improve detection, reduce inappropriate care,

foster cost reduction strategies, savings in antibiotic usage

now in >15 countries

slide34

The Practical Approach to Lung health (PAL)

1. derived from Stop-TB and IMCI.

2.Clinical practice guidelines for respiratory symptoms integrating WHO guidelines for TB control, asthma and COPD management.

3. Targeted and adapted for “Multi-purpose health workers” in low and middle income countries.

4. Studies in progress in several countries (e.g. Chile, Morocco, Peru). Evidence based assessments carried out with the Cochrane Collaboration.

slide35

WHO/MNC/CRA/03.2

STEP

SuRF

Prevention of

Allergy and

Allergic Asthma

Based on the WHO/WAO Meeting on the

Prevention of Allergy and Allergic Asthma

Geneva,8-9 January 2002

FCTC

slide36

OUTLINE

1. WHO and its mandate

2. CRD, a public health priority for the WHA

3. GARD: an ambitious idea

4. GARD: programs against CRD

5. Present status of GARD

slide37

GARD historical background

Before Sep. 2002: brainstorming meetings (Geneva, Montpellier) on the WHO Global Strategy against CRD

Sept. 2002

1st proposal of "WARD" within the WHO CRA Unit

Oct.-Dec. 2002

1st draft GARD bylaws

1st informal mtg with 2 NGO\'s

Jan. 2003

1st proposal to LEG

March-June 2003

CRA Unit mtg with Robert Beaglehole

March 2004

CRA Unit mtg with Serge Resnikoff

May 2004

Brainstorming mtg on GARD with 15 NGO\'s

June 2004

TOR approved by LEG & ADG

Aug 2004

Mtg in Glasgow with founders

Sep 2004

20 NGOs join GARD – donors\' agreements

Nov 2004

Informal meeting

21 Dec 2004

WHO mtg with all partners + p. to be

18-19 Jan 2005

TODAY

mtg of WGs in Geneva

10-11 May 2005

Nov 2005

launch in China

1st An Mtg

May 2006

slide38

GARD - categories of members

(according to the current bylaws)

World NGO

(eg.: WAO)

Reg NGO

(eg.: EAACI)

2

1

Natl NGO

(eg.: TTS)

Gov Org

(e.g.: NHLBI, KTL)

3

9

Foundations

(e.g.: ECARF)

4

WHO-CC

(eg.: Dokkyo Un.)

8

5

Intl. groups

of Experts

(eg.: GINA, ARIA)

7

Intl. Research Networks

(e.g.: GA2LEN)

6

Patients

Associations

(eg: EFA)

slide39

STRUCTURE

Executive Board

Incl. the Chairman

Executive Committee

General Assembly

slide40

Potential structure of a future GARD EC and EB

Executive

Board

Operative area

Working groups

6

5

4

3

2

1

GARD EXECUTIVE COMMITTEE

Vice-Chairman

B

Working groups

Chairman

C

Head CRA Unit (WHO)

D

6

5

4

3

2

1

Delegates of categories of members

Assembly area

slide41

Working Groups

WG-1 Epidemiology and Surveillance

WG-2 Respiratory Health Promotion and Disease Prevention

WG-3 Diagnosis

WG-4 Control and Drug Accessibility

WG-5 Paediatric CRD and Allergy

WG-6 Awareness

slide42

WORKING GROUP

  • A chairman, a vice-ch., WHO professional & members
  • Autonomy and budget
  • Using WHO programs when applicable
  • Acting on country focused activities
  • Measurable outcomes
  • Annual Report
  • Subject to external evaluation (EC, WHO)
  • (One staff professional seconded to WHO)
slide44

The Global Alliance against CRD

GARD: rationale and objectives

of a novel WHO initiative

Nikolai Khaltaev, MD

Chronic Respiratory Diseases TeamWorld Health OrganizationGeneva, Switzerland

8th Annual Congress of the Turkish Thoracic Society

April, 2005

photo: US EPA

ad