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Noncommunicable Diseases: Epidemiology and Pubic Health

Noncommunicable Diseases: Epidemiology and Pubic Health. Dr Nick Banatvala Sixth International WHO IUMSP NCD Managers Seminar May 2012. Global Status. Structure of the presentation. Mortality Morbidity Risk factors Behavioral Metabolic /physical Chronic infections

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Noncommunicable Diseases: Epidemiology and Pubic Health

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  1. Noncommunicable Diseases: Epidemiology and Pubic Health Dr Nick Banatvala Sixth International WHO IUMSP NCD Managers Seminar May 2012

  2. Global Status

  3. Structure of the presentation • Mortality • Morbidity • Risk factors • Behavioral • Metabolic/physical • Chronic infections • Public health impact and reducing the burden of NCDs • What do we need to do to tackle the problem?

  4. NCDs Metabolic/ physiological risk factors Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Behavioural risk factors Globalization Urbanization Population ageing Underlying drivers Causal links SocialDeterminants of Health

  5. 1. Mortality

  6. 57 million deaths in 2008 • 36 million (63%) were NCDs – principally CVD, diabetes, cancer and chronic respiratory diseases • 80% of these deaths in LMICs • 44% NCD deaths before the age of 70 (48% LMIC, 26% HIC) • Women are affected

  7. The top-10 leading causes of death Source:

  8. 10 leading causes of deaths in females (2004) Source: WHO's report on "Women and Health: today's evidence, tomorrow's agenda"

  9. 9% 60 M 28% 50 M 40 M; 30 M 20 M 47% 10 M 16% 0 Non-Communicable Diseases (NCDs): 36 million deaths (63% of global mortality) 2008 estimates Communicable, maternal, perinatal and nutritional conditions NCDs < 60 NCDs > 60 Injuries

  10. 16 M 14 M 12 M 10 M 8 M 6 M 4 M 2 M 0 AFR AMR EMR EUR SEAR WPR NCD deaths by WHO region (2008 estimates) Communicable conditions NCDs < 60 NCDs > 60 Injuries

  11. 35 M 30 M 25 M 20 M 15 M 10 M 5 M 0 M Low-income Countries Lower- Middle-income Countries Upper-Middle-income Countries High-income Countries NCD deaths by World Bank income groups(2008 estimates) Communicable conditions NCDs < 60 NCDs > 60 Injuries

  12. Global burden of NCDs(Millions of deaths in 2008) 18M Males Females 16M 14M 12M 10M 8M 6M 4M 2M 0 Low- Lower- Upper- High- Low- Lower- Upper- High- income middle- middle- income income middle- middle- income income income income income Communicable, maternal, perinatal and nutritional conditions NCDs Injuries

  13. Sierra Leone Afghanistan Equatorial Guinea Nauru Papua New Guinea Gambia Angola Kiribati Ethiopia Andorra Norway Spain Japan Germany Austria Switzerland San Marino Sweden Italy 0% 10% 20% 30% 40% 50% 60% 70% Percentage of women who die from NCDs before the age of 60 (2008)

  14. Under the age of 60 Under the age of 70 12% 16% 27% 28% 9% 11% 4% 3% 9% 8% 39% 34% What are the causes of these NCD deaths? The global picture Cancers Cardiovascular disease Chronic respiratory diseases Diabetes Digestive diseases Other NCDs

  15. 2. Morbidity

  16. Prevalence of diabetes 15% men Men Women 10% 5% Africa Americas Eastern- Mediterranean Europe South-East Asia WesternPacific Age-standardized prevalence of diabetes in adults aged 25+ years (2008) Source: WHO Global Status Report on NCDs (2010)

  17. NCDs Metabolic/ physiological risk factors Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Behavioural risk factors Globalization Urbanization Population ageing Underlying drivers Causal links SocialDeterminants of Health

  18. 3. Metabolic/physical risk factors

  19. Metabolic/physical risk factors • Raised blood pressure • ≥140mmHg and/or ≥ 90mmHg • 40% adults over 25 have raised BP • Causes 7.5 million (13%) all deaths • 3.7% total DALYs • Major risk factor for CHD, ischaemic and hemorrhagic stroke • CVD risk doubles for each increase of 20/10 mmHg • Other complications: heart failure, PVD, renal disease, retinal hemorrhage

  20. High blood pressure continues to go up 40% High-income countries 30% Upper Middle-income countries % of population Lower middle-income countries 20% Low-income countries 10% 0 1980 2008 Raised blood pressure (2008) Source: WHO NCD Country Profiles (2010)

  21. 50% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Low- income Lower- middle- income Upper- Middle- income- High- income Prevalence of raised blood pressure(2008 estimates) Women Both Sexes Men

  22. Metabolic/physical risk factors b) Overweight and obesity • BMI ≥ 25 kg/m2, BMI >= 30 kg/m2 • Population goal: 21-23 kg/m2 • Individual goal: 18.5 to 24.9 kg/m2 • 35% adults aged 20+ overweight • Worldwide prevalence doubled over the last 30y

  23. Risks are widespread:% overweight (BMI 25+), 2008, ages 20+, age adjusted

  24. Obesity among adult men and women (2008)

  25. 70% 60% 50% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Prevalence of overweight in adults(2008 estimates) Women Both Sexes Men

  26. Overweight over the last 30 years 70% 60% 50% High-income countries 40% Upper Middle-income countries % of population Lower middle-income countries 30% Low-income countries 20% 10% 0% 1980 2008 Overweight (2008) Source: WHO NCD Country Profiles (2010)

  27. Metabolic/physical risk factors c) Raised cholesterol • 5.0mmol/l or 190mg/dl or higher • Increases the risk of heart disease and stroke • Third of IHD attributible to high cholesterol • Cause of 2.6 million deaths (4.5% of the total) • 10% reduction in men aged 40 would result in 50% reduction in heart disease over 5 years (and at age 70, 20% over 5y • Global prevalence of raised total cholesterol 39%

  28. 4. Behavioral risk factors

  29. Behavioral risk factors a) Tobacco • 1 billion smokers • 4000 chemicals, 50 carcinogenic • Smoked and unsmoked forms • 6 million die from tobacco use and exposure • 6% all female deaths, 12% male • 10% deaths attributable to second-hand smoke • Causes 71% lung cancer deaths, 42% chronic respiratory deaths, 10% CVD deaths • 7.5 million deaths by 2020

  30. 50% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Prevalence of daily tobacco smoking(2008 estimates) Women Both Sexes Men

  31. Behavioral risk factors b) Insufficient physical activity • Less than x5 30 min moderate activity per week (or x3 20 min vigorous activity) • Globally, 31% those 15y+ insufficiently active • 3.2 million deaths • 20-30% increased risk all-cause mortality • Adequate activity reduces risk of IHD by 30%, diabetes 27%, breast and colon cancer by 21-25%

  32. 50% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Percentage of insufficient physical activity(2008 estimates) Women Both Sexes Men

  33. Behavioral risk factors c) Harmful use of alcohol • Responsible 2.3 million deaths and disabilities • 3.8% of all deaths – 50% from NCDs • Low-risk patterns of consumption may have a beneficial effect • 45% global population never consumed alcohol

  34. Behavioral risk factors d) Unhealthy diet • Overall estimates of unhealthy diet not possible • But 1.7 million deaths (2.8% of the total) attributable to low fruit and low vegetable consumption • Adequate fruit and vegetable intake reduces risk of CVD, stomach and colorectal cancer • Salt consumption important determinant of blood pressure and CVD risk • Recommendation is less than 5g per person • Saturated and trans-fat increase risk of CHD and type 2 diabetes. • Poly-unsaturated fat from vegetables is protective

  35. Chronic infection as a risk factor • Cervical, liver and stomach cancers all have greatest incidence in LMICs • All caused predominately by chronic infections • 2 million cancer cases (18% global cancer burden) attributable to a few specific chronic infections • HPV: 100% cancer cervix, majority of anogenital tract, 20-60% oro-pharyngeal • HBV and HBC: 50-80% primary liver cancer • H. pylori: 80% noncardia carcinomas stomach

  36. NCDs Metabolic/ physiological risk factors Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Behavioural risk factors Globalization Urbanization Population ageing Underlying drivers Causal links SocialDeterminants of Health

  37. 5. Public health impact of NCDs

  38. Public health impact of NCDs • Premature mortality, significant morbidity • Quality of life of affected individuals and families • Socioeconomic impact on individuals, families, communities and societies

  39. NCDs is a development issue Globalization Urbanization Population ageing Poverty Populations in low- and middle-income countries Increased exposure to common modifiable risk factors NCDs Loss of household income Limited access to effective and equitable health-care services Poverty at household level More than 8 million people die before the age of 60 in developing countries from noncommunicable diseases

  40. NCDs: The poor are affected the most Percent with and without cancer experiencing catastrophic spending and impoverishment Cancer 60 50 40 30 20 10 0 No cancer percentage Impoverishment Catastrophic expenditures

  41. NCD risk factors: The poor are affected the most Smoking prevalence (2004) 45 Lowest household income quintiles 40 35 30 Highest household income quintiles 25 (percentage) 20 15 10 5 0 Upper middle-income countries High-income countries Low-income countries Lower-middle income countries

  42. NCDs are the third largest global risk in terms of likelihood Oil spikes Retrenching from globalization Asset price collapse Non-communicable diseases Food price volatility Financial crisis "A problem neither the developed world nor the developing world can afford" "Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the MDGs, at the expense of the prevention and treatment of non-communicable diseases." (WEF Global Risk 2010 Report) Infectious diseases World Economic Forum: Global Risk 2010 Report

  43. US$ 11B is the average yearly cost for all developing countries to scale up action by implementing a combined set of "best buy" priority NCD interventions identified by WHO US$ 7T is the cumulative lost output in developing countries associated with NCDs between 2011-2025

  44. 7. Prevention is possible • Largest part of premature mortality from the four main NCDs can be prevented if risk factors were eliminated • 20% • 20% • 20% • 60% • 40% • 80% • 80% • 80% Heart disease Stroke Type 2 diabetes Cancer • preventable not preventable

  45. 8. What is needed to tackle this public health problem?

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