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Subregional Meeting of Representatives and Directors from Central America, Cuba, the Dominican Republic, Haiti, Mexico, and the US-Mexican Border Field Office Session 5:  Noncommunicable Diseases (Belize, 12–16 February 2007). Overview. Global situation

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Subregional Meetingof Representatives and Directors from Central America, Cuba, the Dominican Republic, Haiti, Mexico, and the US-Mexican Border Field Office

Session 5: Noncommunicable Diseases

(Belize, 12–16 February 2007)


Overview

  • Global situation

  • National Capacity Survey forCentral America

  • Review of effective interventions

  • Regional Strategy and Plan of Action

  • CAMDI Initiative

  • PAHO Actions

  • Next Steps


Global Situation

Chronic diseases are the major cause of death in almost all countries!

60% of all deaths are due to chronic diseases.

Over 35,000,000 people will die from chronic diseases in 2007.


Global Situation 2

The poorest countries are the worst affected!

80% of chronic disease deaths will occur in low- and middle-income countries.

The problem has a serious impact.


Global Situation 3

  • The risk factors are widespread.

  • The threat is growing.

  • 1,000,000 people are overweight or obese.


Source: WHO, Preventing Chronic Diseases, A Vital Investment.


Global Situation 4

  • The global response is inadequate.

  • 388,000,000 million people will die in the next 10 years of a chronic disease.


Global Situation

  • The major causes of chronic diseases are known.

  • At least 80% of heart disease, stroke and type 2 diabetes, and 40% of cancer can be prevented.

  • A full range of cost-effective interventions exist for all regions of the world. Many are inexpensive.

  • We must strike a new balance of prevention and control.


National Capacity Survey / Central America

NOTE: X= NOT PRESENT


National Capacity Survey.Central America

  • Deficient areas

    • Financial resources.

    • Quality of care / Monitoring System

    • National health-reporting system, surveys and surveillance.

    • National community-based demonstration program.


What works?

  • A small shift in average population levels of several risk factors can lead to a large reduction in chronic diseases.

  • Population-wide approaches form the central strategy for preventing and controlling chronic disease epidemics, but should be combined with interventions for individuals.

  • Many interventions are not only effective, but suitable for resource-constrained settings.


Review of Effective Interventions

  • Laws and Regulations

  • Tax and Price Interventions

  • Improving the built environment for physical activity

  • Advocacy, communication and information

  • Community based interventions

  • School-based interventions

  • Workplace interventions

  • Screening - CVD, diabetes, HBP, some cancers

  • Clinical prevention: focus on overall risk

  • Disease Management

  • Rehabilitation

  • Palliative care


Health Promotion Strategies

  • Improve management of existing disease

  • Healthy public policy

  • Reorienting health services

  • Creating supportive environments

  • Strengthening community action

  • Developing personal skills

  • Building partnerships and alliances


Role of the Health Sector

  • Advocacy at all times, by all health workers

  • Advances in disease prevention (primary, secondary and tertiary care)

  • Collaboration with partners in health promotion

  • Catalyst for human safety and development, working with “all of society”


Regional Strategy and Plan of Action on an Integrated Approach to the Prevention & Control of Chronic Diseases


Goal Indicator

  • A 2% annual reduction in chronic disease death rates from the major chronic diseases, over and above current trends

  • Globally, to prevent 36 million deaths in the next 10 years


Public Policy

To ensure and promote the development and implementation of effective, integrated, sustainable, and evidence-based public policies on chronic disease, their risk factors, and determinants.

Strengthen NCD public policy development


Development & strengthening of chronic disease and risk-factor surveillance systems

Surveillance

To encourage and support the development and strengthening of countries’ capacity for better surveillance of chronic diseases, their consequences, their risk factors, and the impact of public health interventions.


Health Promotion & Prevention

To foster, support, and promote social and economic conditions that address the determinants of chronic diseases and empower people to increase control over their health and to adopt healthy behaviors.

Tobacco, Alcohol, Diet & Physical Activity

Home, School, Community, Workplace


Provide technical assistance to countries in the development, strengthening, implementation, and evaluation of their chronic- disease programs

Integrated NCD Management

To facilitate and support the strengthening of the capacity and competencies of the health system for the integrated management of chronic diseases and their risk factors.


StepWise Implementation

Step 3: Desirable

Step 2: Expanded

Step 1: Core


Consultation for Central America and Mexico


Consultation for Central America and Mexico


Action at Different Levels in Support of Strategy in Central America

  • National Ministry of Health

    • Local and Municipal

    • PAHO/WHO Country Offices

  • Subregional, e.g. PAHO/INCAP, SICA, RESCA,

  • Regional, e.g. PAHO-Washington, OAS, Summits

  • Global, e.g. WHO-Geneva


What is available to us now?

  • Strategic partnerships:

    Interinstitutional: CDC, NHLBI, Canada, partnering universities, CIP, BID, World Bank,

    Networks: CARMEN, bicycle paths, fruits & vegetables, AMNET, RAFA

  • Political progress

    Tobacco: Ratification of the Framework Convention for Tobacco Control (FCTC)CARMEN Policy Observatory


What is available to us now?

  • Surveillance instruments

    Basic Data Initiative, Pan American STEPS

  • Scientific evidence

    Promotion & prevention: Healthy Lifestyles Project, Healthy People

    Integrated management & surveillance: Central American Diabetes Initiative (CAMDI), Veracruz Initiative for Diabetes Awareness (VIDA)

  • Capacity-building

    CARMEN School


What is available to us now?

  • Healthy food

    • 5-a-Day Initiative

    • Healthy Lifestyles Project

  • Physical Activity

    • Urban planning: Green spaces, safe streets

    • Alternative forms of transport: Bicycle paths

    • Agita (Move!) Movement in São Paulo (RAFA-PANA)

    • ActiveCities Contest, Healthy Cities Project

http://www.ciudadhumana.org/concursociudades/index.htm


http://www.dpaslac.org/


1

Design

Final evaluation & sharing lessons learned in Latin America.

Lessons learned

and

final evaluation

About the

Campaign

Initial stage of the campaign, starting between July and August 2006.

5

2

Launching &

partnerships

Between September 2006 and February 2007, campaign media messages will scale up and the scope of activities to promote the campaign will be broadened.

Identification ofBest Practices

3

4

Country activities

From March–October 2007, the countries will start to act. The Roadshow & Best Practices Contest will be part of the regional activities.


Central American Diabetes Initiative


CAMDI Workshops

I: San Salvador, March 8-9, 2000

II: Tegucigalpa, November 13-14, 2000

III: Guatemala City, August 12-14, 2002

IV:Tegucigalpa, July 8-9, 2003

V: Montelimar, Nicaragua April 29-30, 2004

VI: Miami, FL, May 4-5, 2005

VII: Jacó, Costa Rica, March 13-15, 2006

VIII: Panama City, November 28-29, 2006


Main CAMDI Results: Population-Based Survey of Chronic Diseases and Their Risk Factors

Preliminary Results


Sample Size, Survey Participants Tested by Country: The CAMDI 1 Study


Results of the Risk-Factor Survey, 2003–2006


Hypertension


Diabetes Mellitus


CAMDI:Quality of Care for Chronic Diseases

Quality of Diabetes Care: Preliminary Analysis

Quality of HypertensionCare:In progress


Methodology

  • Medical chart review

  • Primary, secondary and tertiary care clinics

  • Centers selected by national teams

  • Standardized data collection

  • Records randomly selected


Use of Medication by Country


Proportion of Records with A1c Results, and Information on Blood Pressure and Height, by country


Proportion of Patients with Documented Foot and Eye exam, by country


Glycemic* and Blood Pressure** Control, by country

* A1C<7 or fasting glucose<130 ** BP<140/90


Adjusted* Proportion of Cases with Good Glycemic Control, by Country

  • *Adjusted by age, gender, type of clinic and insulin use;

  • ** Glycated hemoglobin (A1c) < 7% or Fasting Blood Glucose < 130 mg/dl


  • Progress Report

    • Multicenter analysis in progress.

    • Final report for Guatemala City survey being published.

    • Peer-reviewed papers on the methodology and prevalence of DM in progress.

    • QUALIDIAB Final Report circulated (Guatemala, Honduras, Nicaragua, El Salvador, Costa Rica).


    Progress Report

    Health Technology Assessment finished.

    Qualitative analysis: Focus group results available for Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua.

    Intervention started in Costa Rica.

    QUALIHIPER data collection in progress.


    CAMDI 2: Quality of Care and Health Promotion

    Intervention about to start in El Salvador, Guatemala, Honduras and Nicaragua.

    Grant obtained from WDF.

    CAMDI 3:Surveillance System

    • Expansion to national survey using STEPS Centroamericano.

    • Extension to continuous surveillance.

    • New grant from CDC.


    Actions

    • Internal and external partnership to mobilize support.

    • Inter programmatic group under Assistant Director.

    • Technical advisory group to give scientific guidance.

    • Permanent Forum on Chronic Diseases.

    • Refreshing CARMEN vision and mission.

    • Accompanying CCS processes with the Country Support Unit (CSU).


    Actions

    • Regional level

      • Surveillance STEPs

      • Policy and Advocacy

      • Prevention and Promotion

      • Integrated Management

      • Cancer

    • Supportive Strategies

      • Communication strategy

      • Resource mobilization


    Next Steps

    • Advocacy and collaboration at national and subregional levels.

    • Integrated approach to the double burden of undernutrition and overnutrition.

    • Improving implementation of current plans, projects, support to countries.

    • Planning for chronic disease in BPB 08-09.

    • Technical Cooperation in the Countries (TCC) project possibilities.


    Conclusions


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