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WHO Collaborating Centers In Iran meeting with WHO Colleagues June 4,2014 . Reza Malekzadeh M.D Professor of Medicine Deputy for Research and Technology MOHE IR Iran. WHO Collaborating Centres. Digestive Disease Research Institute, TUMS

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Who collaborating centers in iran meeting with who colleagues june 4 2014

WHO Collaborating Centers In Iranmeeting with WHO ColleaguesJune 4,2014

Reza Malekzadeh M.D

Professor of Medicine

Deputy for Research and Technology


Who collaborating centres
WHO Collaborating Centres

  • Digestive Disease Research Institute, TUMS

  • Endocrinology & Metabolism Research Institute, TUMS

  • Research Centre for Diseases of Ear, Nose Throat, IUMS

  • Mental Health Research Centre, IUMS

  • Centre for Nursing Care Research, IUMS

  • National Research Institute of Tuberculosis and Lung Disease, SBMU

  • Community Oral Health Department, School of Dentistry, SBMU

  • Ophthalmic Research Centre, SBMU

  • Tobacco Prevention and Control Research Centre, SBMU

  • Educational Development Centre, SBMU

  • Isfahan Cardiovascular Research Centre, MUI

  • Regional Knowledge Hub for HIV/AIDS Surveillance, KMU

  • National Public Health Management Centre, TBZMED

  • Rabies Research Department, Pasteur Institute of Iran, MOHME

  • Reference Health Laboratories, MOHME

  • Iranian Blood Transfusion Organization (IBTO)

Who collaborating centres p ending status
WHO Collaborating CentresPending Status

  • National Nutrition and Food Technology Research Institute, SBMU

  • Research Institute for Endocrine Sciences, SBMU

  • Scientific Publication and Information Development Center, MOHME

Proposal for designation as whocc
Proposal for designation as WHOCC

  • National Institute of Health Research, TUMS

  • Institute for Environmental Research, TUMS

  • Safety Promotion and Injury Prevention Research Centre, SBMU

  • Toxicological research Centre, SBMU

  • Health Policy Research Centre, SUMS

  • Occupational Health Research Centre,IUMS

  • Institute for Futures Studies in Health, KMU

  • Malarial and Vector Research Group, Biotechnology Research Centre, Pasteur Institute of Iran

  • Reference Food and Drug Laboratories, FDO

  • Noor Ophthalmology Research Centre

Who collaborating centres potential centres candidates
WHO Collaborating CentresPotential Centres Candidates

  • Centre for Research and Training in Skin Disease and Leprosy, TUMS

  • Sina Trauma and Surgery Research Centre, TUMS

  • Growth and Development Research Centre, TUMS

  • Psychiatry and Psychology Research Centre, TUMS

  • Food Security Research Center, MUI

  • ZahedanHealth Promotion Research Centre, ZAUMS

  • Liver and Gastrointestinal Diseases Research Centre, TBZMED

Health in the islamic republic of iran

Health in the Islamic Republic of Iran

May 2014

Global burden of disease gbd study iran 2010
Global Burden of Disease (GBD) Study Iran, 2010

Archives of Iranian Medicine May 2014

special ISSUE

History of gbd
History of GBD

  • GBD is the largest study on health at global, regional, and national levels

  • GBD has been started since 1990 with collaboration of 486 researchers from 302 research center in 50 countries

  • Methodologically, GBD is a systematic review of all published and unpublished data at national levels in 188 countries from 1990 to 2010

  • In GBD, novel statistical methods have been used to estimate prevalence of diseases and risk factors in places and times where no data is available

Main features of gbd
Main Features of GBD

  • Innovation of indicators that make possible the comparison of burden of diseases between different countries, in different regions, and different time frames

  • Innovation of indicators that measure not only diseases (289 diseases) and risk factors (67 risk factors), but also health, quality of life, and disability

Epidemiological transition
Epidemiological Transition

  • In developing countries, a trend from communicable diseases to non-communicable chronic diseases has been observed

  • The epidemiological transition is an evident sign of development in a developing country

Gbd 2010 iran
GBD 2010 Iran

  • Burden of 67 risk factors and 291 diseases for three time points (1990, 2005, and 2010) during the last 20 years in Iran*

  • The obvious finding is a shift away from premature death to years lived with disability and from infectious and communicable etiologies to chronic non-communicable diseases (NCDs)

*AIM 2014 May

Two decades increase in life expectancy
Two Decades increase in Life expectancy

  • Despite post revolution conflicts, an 8-year war, tight economic sanctions by Western countries, and multiple earthquakes over the last three decades:

  • Life expectancy increased by 22 years for women and 21 years for men

Results 2010 gbd
Results 2010GBD

  • Total number of deaths in 2010 in Iran: 351,814

  • Deaths in men in 2010: 223,768

  • Deaths in women in 2010: 128,045

  • Transport accidents have been the main causes of YLL

Ncds in global scale
NCDs in global scale

Causes of death, 1990

Causes of death, 2010

GBD 2010

Ncds in iran
NCDs in Iran

Causes of death, 1990

Causes of death, 2010

GBD 2010

Main ncds in iran
Main NCDs in Iran

Fatal Diseases

Ischemic Heart Disease




Transport accidents


Non-fatal disabling Diseases

Mental Diseases

Musculoskeletal Diseases


Transport accidents

Chronic Respiratory Diseases

Unintentional Injuries

GBD 2010

Factors influencing the epidemiological transition
Factors Influencing the Epidemiological Transition

  • Increased Literacy Rate

  • Modernization

  • Increased Urbanization

  • Increased Socio-Economical Status

  • Change in life style towards Western Style


  • The efficiency of the health system in prevention and control of communicable, maternal, and neonatal diseases and nutritional disorders

Achievements of health system in iran
Achievements of Health System in Iran

  • Increased life expectancy at birth by 22 years despite war, earthquakes, and economical sacntions

  • Decrease in mortality rates in all ages

  • Decrease in mortality rates among children under 5 years old

  • Decrease in maternal mortality rates

  • Decrease in fertility rates

Ministry of Health and Medical Education

Achievements of health system in iran1
Achievements of Health System in Iran

  • The percentage of iodinated salt surpasses 95%

  • The vaccination coverage of BCG, DPT, Polio, MMR, and hepatitis B surpassed 99%

  • Polio is eradicated

  • The prevalence and incidence of main communicable diseases including malaria, typhoid, and tuberculosis has decreased

Ministry of Health and Medical Education

The trend in control of malaria from 1994 to 2012
The Trend in Control of Malaria from 1994 to 2012 2011

Ministry of Health and Medical Education

Trend in control of typhoid from 1962 to 2010
Trend in Control of Typhoid from 1962 to 2010 2011

Ministry of Health and Medical Education

The trend in incidence of tuberculosis
The Trend in Incidence of Tuberculosis 2011

Ministry of Health and Medical Education

Trend in detection and control of hiv
Trend in Detection and Control of HIV 2011

  • Prevalence of HIV/AIDS in patients suffering from tuberculosis:

    in 2010: 3.8%

    in 2012: 2.5%

Ministry of Health and Medical Education

Improvement of infrastructure
Improvement of Infrastructure 2011

  • The achievement of campaigns for construction and literacy, increased GDP per capita, and the establishment of primary health care system in Iran:

  • Increased access to healthy drinking water

  • Increased access to healthy waste

  • Increased access to electricity and gas

  • Improved roads between cities

The age structure in iran 2013
The age structure in Iran 2013 2011

Statistical Center of Iran

Population of iran from 1956 to 2011
Population of Iran from 1956 to 2011 2011

Statistical Center of Iran

Urbanization in iran from 1956 to 2011
Urbanization in Iran from 1956 to 2011 2011

Statistical Center of Iran

Access to drinking water and healthy waste in rural areas from 2006 to 2010
Access to Drinking Water and Healthy Waste in Rural Areas from 2006 to 2010

Statistical Center of Iran

The number of hiv aids deaths
The Number of HIV/AIDS Deaths from 2006 to 2010

Ministry of Health and Medical Education

The necessity of change in the health system
The Necessity of Change in the Health System from 2006 to 2010

  • The necessity of changing policies based on new needs and priorities of the health system

  • The necessity of integrating service packages into the current health system to control NCDs and accidents

  • The necessity of inter-sectoral collaboration

  • The necessity of cost effective planning for optimal allocation of limited financial resources

Non communicable diseases
Non-Communicable Diseases from 2006 to 2010

  • NCDs are main threats to economy

  • NCDs lead to inequality in income, decrease in household wealth, increase in health care cost, and decease in productivity

    Prevention is crucial

Mental diseases
Mental Diseases to 2010

  • Prevalence in different regions in Iran: 29%

  • Prevalence in Tehran:

    • In 1998: 21.5%

    • In 2007: 34.2%

  • Lifetime risk of incidence: 14.3%

  • Prevalence in women: 14.3%

  • Prevalence in men: 7.3%

The trend in prevalence and burden of main ncds
The Trend in Prevalence and Burden of Main NCDs to 2010

  • Necessity of national surveys to measure and monitor those diseases that impose most burden on Iranians

  • Necessity of improving the quality of routine data

  • The Golestan Cohort Study is the largest prospective study in Middle East has released comprehensive results

* to 2010

*Gastro-Esophageal Malignancies In Northern Iran

Arch Iran Med. 2013 Jan;16(1):46-53. doi: 013161/AIM.0014.


Golestan cohort study gcs
Golestan to 2010 Cohort Study (GCS)

  • This is a prospective study on 50,045 subjects 40 to 75 years old

  • Recruitment of subjects in 326 villages and Gonbad city, from 2004 to 2008

  • Subjects consisted of 57% women, 8% rural dwellers, and 74% Turkmens

  • Data collected:

    • Demographic

    • Life style

    • Anthropometric

    • Biochemical samples

    • 10 year follow up

Prevalence of hypertension
Prevalence of Hypertension to 2010

GCS 2007

Prevalence of diabetes
Prevalence of Diabetes to 2010

GCS 2007

Prevalence of overweight and obesity
Prevalence of Overweight and Obesity to 2010

  • Prevalence of overweight: 62.2%

  • Prevalence of obesity: 28%

  • Comparing to United States:

    • Iranian women are more obese than American women

    • Iranian men or thinner than American men

GCS 2007

The Prevalence of Overweight and Obesity in Iranian and American men and women in GCS

Baharmih,Malekzadeh R BMC public health 2006

GCS 2007

Epidemic of overweight obesity and lack of physical activity
Epidemic of Overweight, Obesity, and Lack of Physical Activity

  • Prevalence of Overweight: 38%

  • Prevalence of Obesity: 22%

  • Significant decrease in physical activity especially among women

  • Prevalence of Diabetes: 10%

  • Prevalence of fatty liver: 30%

GCS 2007

Diet Activity

  • Prevalence of excess consumption: 40%

  • Iranian diet: 40% excess carbohydrate, 30% excess oil

  • High consumption of white rice: Iran is the 13th country in the world in terms of excess consumption of rice (46 kg per person per year)

Non-Communicable Diseases Surveillance Survey 2009

The main risk factors of ncds
The Main Risk Factors of NCDs Activity

Non-Communicable Diseases Surveillance Survey 2009

The most prevalent of ncds risk factors among adolescents and youth
The Most Prevalent of NCDs Risk Factors among Adolescents and Youth

CASPIAN Kelishadi et al 2008, 2007

Risk factors in adolescents and youth
Risk Factors in Adolescents and Youth and Youth

  • 10 to 18 years

    • Second hand smoking: 50.6%

    • Low physical activity: 36%

    • Smoking: 12%

  • 15 to 24 years

    - Low physical Activity: 34.5%

    - Overweight: 28%

    - Smoking cigarettes and Hookah: 8%

CASPIAN Kelishadi et al 2008, 2007

Drug abuse
Drug Abuse and Youth

  • Iranians consumes 42% of all opium in the world (?)

  • Transit from Afghanistan to Iran

  • Drug abuse as a leisure or due to beliefs on its therapeutic effects

Drug abuse1
Drug Abuse and Youth

  • Prevalence of drug abuse in subjects 40 years old and older in GCS: 17%

  • The mean proportion of adolescents who abuse drugs (Kerman, Zanjan, Shiraz, Tabriz):

    • Boys: 12.7% - 26.5%

    • Girls: 7.7% - 11.5%

Sequelae of drug abuse
Sequelae and Youth of Drug Abuse

  • Increased all-cause mortality rate

  • Increased mortality rate due to cardiovascular diseases and cancers

  • Increased mortality rate due to asthma, tuberculosis, and chronic respiratory diseases

GCS 2012

Alcohol consumption
Alcohol Consumption and Youth

  • High School Adolescents:

    • Boys: 18%

    • Girls: 8%

CASPIAN Kelishadi et al 2008, 2007

Environmental risk factors
Environmental Risk Factors and Youth

  • Expansion of slum areas without access to health care and low sanitation

  • Air and noise pollution in cities

  • Exposure to poisons in work places

  • Limited water sources and the risk of drought

  • Use of fossil fuels

  • Inequity in access to fuels

  • Destruction of jungles and green spaces

Management and Quality of Health Care for NCDs at National Level

Non-Communicable Diseases Surveillance Survey, 2005

Management of ncds
Management of NCDs Level

  • Necessity of research on prevalence of Diseases, communicable and non-communicable at provincial level for cost-efficient policy making

  • Necessity of detecting risk factors for prevention

The Coverage of Diabetes and Hypertension Diagnosis and Treatment in Urban and Rural Areas of Iran, 2005

Non-Communicable Diseases Surveillance Survey 2005

The association of risk factors with ncds

The Association of Risk Factors with NCDs Treatment in Urban and Rural Areas of Iran, 2005

GBD 2010 Treatment in Urban and Rural Areas of Iran, 2005

GBD 2010 Treatment in Urban and Rural Areas of Iran, 2005

The pathway from risk factors to ncds
The Pathway from Risk Factors to NCDS Treatment in Urban and Rural Areas of Iran, 2005

Direct Health Care Costs



Raised Blood Pressure, Obesity, High Blood Glucose, High Lipids

Indirect Costs due to Income and Productivity Losses

Unhealthy Diet, Smoking, Physical Inactivity, Substance abuse

Social Determinants of Health

Globalization, Urbanization, Population Ageing

Impact on socio economic development a vicious circle 2
Impact on Socio-Economic Development: A Vicious Circle (2) Treatment in Urban and Rural Areas of Iran, 2005

High costs due to chronic nature of diseases

Needs to access drugs and health services

Treatments not part of core services

Probable needs to seek services and drugs in private sector

Increased Out-of-Pocket

Catastrophic Expenditure

Financial turnover in health system in iran
Financial Turnover in Health System in Iran Treatment in Urban and Rural Areas of Iran, 2005

  • Total Health Expenditure

  • The proportion of health expenditure out of GDP

  • Out of Pocket

  • The share of public and private insurance organizations

  • Insurance coverage

  • Catastrophic expenditure

  • Payment Mechanism

Gdp billion dollars from 1999 to 2013
GDP (Billion Dollars) from 1999 to 2013 Treatment in Urban and Rural Areas of Iran, 2005

Statistical Center of Iran

Trend of health expenditure by financial sources billion rials
Trend of Health Expenditure by Financial Sources (Billion Treatment in Urban and Rural Areas of Iran, 2005Rials)

Ministry of Health and Medical Education, National Health Accounts

Trend of health expenditure by health care functions billion rials
Trend of Health Expenditure by Health Care Functions (Billion Rials)

Ministry of Health and Medical Education, National Health Accounts

Trend of health expenditure by providers billion rials
Trend of Health Expenditure by Providers (Billion (Billion Rials)

Ministry of Health and Medical Education, National Health Accounts

The proportion of total health expenditure out of gdp in iran
The Proportion of Total Health Expenditure out of GDP in Iran

Data: WHO (Global Health Expenditure Database)

Total health expenditure per capita
Total Health Expenditure Per Capita Iran

Data: WHO (Global Health Expenditure Database)

Out of pocket expenditure as of total health expenditure
Out of Pocket Expenditure as % of Total Health Expenditure Iran

Data: WHO (Global Health Expenditure Database)

Percentage of catastrophic expenditure
Percentage of Catastrophic Expenditure Iran

Data: Household Expenditure Survey

Challenges in health system 1
Challenges in Health System (1) Iran

  • Limited Financial Resources

  • Lack of accordance between the capacity of health system and the need for prevention, control, and treatment of NCDs

  • Incomplete insurance coverage and high percentage of out of pocket and catastrophic expenditure

  • Increase in induced demands

  • No implementation of referral system in urban areas

Challenges in health system 2
Challenges in Health System (2) Iran

  • No insurance coverage in slums areas

  • Inequity in access to health care

  • Low quality of health care

  • Low satisfaction of health care

  • Lack of an appropriate approach towards Health Technology Assessment

  • Focus on treatment instead of prevention

  • Lack of evidence-based policy making

  • Low quality of health data infrastructure

What should we do
What should we do? Iran

  • Reconfigure the current primary care system to be responsive to the new burden estimates.

  • Fast and cost-effective move toward a system that focuses on preventing NCDs and road injuries

The alternative no action scenario
The alternative no-action Iranscenario :

  • Is secondary and tertiary prevention of these conditions that will impose enormous financial costs on the system and, indirectly, on the population.

Ir phc is not well prepared for ncd challenges
IR IranPHC is not well prepared for NCD challenges

  • The PHC in Iran, similar to several other health systems in LMIC, is not well prepared for confronting the challenges caused by the epidemics of NCDs because of its typical policy direction toward preventing maternal-child conditions and infectious diseases

The policy message
The policy message Iran

  • Nationwide, low-cost, early, and sustainable interventions are needed to mitigate NCDs’ increasing burden

Ncd challenge
NCD Challenge Iran

  • Prevention, early diagnosis and care of NCDs need a different and well prepared health infrastructure to avert huge co-morbidities which contribute greatly to rising health care costs and compromise of economic productivity

Ministry of health and medical education mohme undersecretary of research and technology

Ministry of Health and Medical Education ( IranMoHME)Undersecretary of Research and Technology

Strategic Plan (2014-2019)

June 2014

Strategic plan 2014 2019 strategic aim one
Strategic Plan (2014-2019) IranStrategic Aim One

Strategic Aim One:

Strengthening Health Research Infrastructure

1-1- Reestablish of the National Research Center for Medical Sciences

1-2- Disease Registries Program

1-3- Cohort Studies

  • in adult (min. 100,000 population per study)

  • in neonates and children (min. 2,000 population per study)

Why cohort studies
Why Cohort Studies? Iran

  • UK Medical Research Council (MRC)has a 50-year history of supporting population cohort studies, including:

  • British 1946 Birth Cohort: the world’s longest continuously running birth cohort

  • UK Biobank: which tracks half a million participants.

  • Million Women Study: the largest longitudinal study of women’s health

  • 2·2 million people in the UK are currently taking part in these large population cohort studies—one in 30 of the general population

Why Cohort Studies? Iran

34 largest UK population cohort studies:

  • Almost £30 million is spent per year on the 34 largest UK population cohort studies

  • 50% of these cohort have been followed for more than 20 years

  • 92% of cohort participants are aged 45 years or older

  • 62% are female

Why Cohort Studies? Iran

What are the strength of Cohort study?

  • Ability to identify multiple risk factors over time

  • Assessment of exposures that cannot be randomized (smoking, alcohol,…)

  • Collection of serial measurements and samples that enables measurement of changes in exposure and their effect on health outcomes over time

  • Identifying the effect of one risk factor on multiple outcomes

  • Cohorts are generally more inclusive than RCTs which are usually highly selective

  • Findings from cohort studies can, therefore, be more generalizable to the population as a whole

  • Feasibility of further research through linkage to routine data and further laboratory and genetic study

Why Cohort Studies? Iran

Cross-cohort collaborations

  • An effective way to increase statistical power

  • The Healthy Ageing Across the Life Course (HALCyon) collaboration merged data from nine cohorts to undertake studies of ageing that would not have been feasible using any single cohort

  • Cohort and Longitudinal Studies Enhancement Resources (CLOSER) initiative, funded by the MRC and Economic and Social Research Council, brings together nine cohorts with the aim of combining variables across these studies

  • Cohorts should use standardized and validated approaches, where possible, to facilitate cross-cohort comparisons

Strategic Plan (2014-2019) IranStrategic Aim One

1-4- To Build Core Laboratories in 10 Medical Universities

1-5- Development of Cutting-Edge Science

  • Iran National Brain Mapping Center

  • Regenerative Medicine Centre

  • Iranian Genomes Project

    1-6- Application of Electronic Health Records in Clinical, Epidemiologic and Health Management Research

Strategic plan 2014 2019 strategic aim two
Strategic Plan (2014-2019) IranStrategic Aim Two

Strategic Aim Two:

Capacity building for academic and research staff

2-1- Clinician Scientist Training Program

2-2- Postdoctoral Research Program

2-3- Improving the Quality of PhD by Research Program

2-4- Research Grant for Top Scientists (with high ranked h-index)

2-5- International Collaboration with Health and Biomedical Research Centers

Strategic plan 2014 2019 strategic aim three
Strategic Plan (2014-2019) IranStrategic Aim Three

Strategic Aim Three:

Health Technology Development

3-1- Clinician Scientist Training Program

3-2- Development of Incubators in Medical Universities

3-3- Supporting Knowledge-Based Companies in Health and Biomedical Field

Strategic plan 2014 2019 strategic aim four
Strategic Plan (2014-2019) IranStrategic Aim Four

Strategic Aim Four:

Development of Sources of Health Research Funding

4-1- Allocation of at least one percent of a medical university’s budgets for research

4-2- Supporting establishment of non-governmental health and biomedical research centers

4-3- Development of health and biomedical research charities

4-4- Absorption of funds for health research from other governmental sources

“Development of Research and Technology” Budget Chapter Iranin Ministry of Health Compared to Ministry of Science (1393)

Research budget in iranian medical universities research centers and ministry 1393 compared to 1392
Research Budget in Iranian Medical Universities, Research Centers and Ministry (1393 compared to 1392)

Charitable spending on research in the uk 2008 2012
Charitable spending on research in the UK 2008-2012 Centers and Ministry

Medical research charities have consistently spent more than £1bn on research in each of the past five years

See more at: http://www.amrc.org.uk/our-members/sector-data/research-spend#sthash.U2ZGARpv.dpuf

Strategic plan 2014 2019 strategic aim five
Strategic Plan (2014-2019) Centers and Ministry Strategic Aim Five

Strategic Aim Five:

Enhancing the Quality of Health Research

5-1- Improving assessment of health research and researchers

5-2- Quantitative and Qualitative Development of “Health System Research”

5-3- Supporting Iranian Medical Journals for Indexing in MEDLINE, ISI Web of Science and Scopus as well as Enhancing Their Quality

5-4- Improving Peer-Review System in Health Research and Technology Assessment

5-5- Shifting Authority of Medical Journals from Public Universities to Scientific Medical Associations and NGOs