BK F OUNDATION HEALTH AWARENESS - CHRONIC DISEASES

1. BK FOUNDATION HEALTH AWARENESS - CHRONIC DISEASES JOSEPH ANA CHAIRMAN BOARD OF TRUSTEES BK EDUCATION FOUNDATION

2. OBJECTIVE PARTICIPANTS TO HAVE AN INCREASED AWARENESS OF CHRONIC DISEASES AND THEIR PREVENTION AND AVOIDANCE

3. WHAT IS KILLING PEOPLE IN THE WORLD

4. Global Causes of Death (2006) • INFECTIOUS DISEASES: • HIV/AIDS 4.9% • TB 2.4% • Malaria 1.5% • Other inf. Dses 20.9% • Injuries 9.3% CHRONIC DISEASES: • Heart disease 30.2% • Cancer 15.7% • Diabetes mellitus 1.9% • Others 15.7% The total number of people dying from chronic (58 MILLION) is double that of all infectious diseases including HIV/AIDS, tuberculosis and malaria (Nature, 2007).

5. DOUBLE WHAMMY OF KILLER- DISEASES IN NIGERIA • Infections • Chronic disease

6. IN NIGERIA 2012

7. CHRONIC DISEASES

8. ADD MENTAL ILLNESS!

9. Did you know?? 35 000 000 people died from chronic diseases in 2005

10. COMMON DENOMINATORS • smoking • Lack of exercise • Food abuse • Alcohol abuse

11. 10 widespread misunderstandings about chronic disease - and the reality • Chronic disease epidemic is rapidly evolving • Global recognition and response has not kept pace • Misunderstandings can be dispelled by the strongest evidence

12. Reality: 80% of chronic disease deaths occur in low & middle income countries

13. Reality: double burden = double response

14. Reality: chronic diseases are concentrated among the poor and chronic disease is one of the main reasons that families are pitched into poverty

15. Facing illness and deepening poverty

18. Reality: poor and children have limited choice

19. The next generation

20. 20% • 20% • 20% • 60% • 40% • 80% • 80% • 80% • Heart disease Stroke Type 2 diabetes Cancer • preventable • not preventable Reality: 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable

21. Reality: inexpensive and cost-effective interventions exist

22. Reality: these people are the rare exceptions

23. Reality: death is inevitable but it does not need to be slow, painful or premature

24. Dying slowly, painfully and prematurely

25. Three risk factors • Three risk factors cause four chronic diseases that cause over half of deaths worldwide. • The risk factors are: Tobacco use Lack of physical activity Unhealthy diet

26. ADDITIONALS • ALCOHOL ABUSE – complex • OBESITY - complex

27. chronic, life long infectious and non-infectious diseases Complex interventions Decades before impacts Main levers outside health service control Takes a whole university and all government! Old and new agendas for global health acute childhood infections maternal deaths Simple technologies Rapid impact Controlled by health services Within the remit of the health campus and the health department

28. What works? Comprehensive and integrated action is the means to prevent and control chronic diseases

29. Multiple interventions are effective Cigarette smoking is influenced by • Fiscal measures – high taxation • Advertising bans • Prohibiting smoking in public places • No vending machines available • Health campaigns to stop smoking • Transport smoking bans • Campaign groups • Health warnings on packets • Medical advice repeatedly

30. Diet – changing what we eat Nutrition transition • Worldwide, there is an accelerating move towards a diet high in saturated fats, sugar and refined foods, but low in fibre. • Average food consumption per person is likely to increase from 2,680 kcal in 1997–1999 to almost 3,000 kcal by 2030. Source: UN FAO, 2004

31. Diet – changing what we eat What is driving the nutrition transition? • The cost of industrial fat has fallen by 50% in the last 50 years, whereas the cost of a healthy ingredient such as fruit has increased by one third. • Salt provides flavour to cheap food at around $150 (£84) a tonne. Real spices cost up to $2,000 a tonne. Source: The Guardian, 25 April 2006

32. Diet From this… 34oz 12oz 16oz 20oz 8oz

33. Diet 50 tsp (200g) of sugar (Coca-Cola) … to this! 64oz 16oz 44oz 52oz 32oz Source: Brownell, 2005

34. A rough example • There are 1,144 kcal in a McDonald’s quarter-pounder with cheese, small fries and a small chocolate milkshake • This is approximately 70% of the recommended daily calorie intake of a 10-year-old girl • To work off 1,144 kcal, a child weighing 87 lbs would have to walk at 3 mph for about six hours Source:McDonalds; AAFP; The fitness calculator

35. Physical activity transition A transition in physical activity is occurring – we lead increasingly sedentary lives: • desk jobs replace manual work • labour-saving devices make housework easier and less time consuming • transportation options remove the need to walk or cycle • safety fears keep children – and older people – indoors.

36. Personal characteristics Motivating people/orgs Motivating factors Influences on physical activity Distance to work/school Work/school Playing fields Work gym Changing facilities PE / lunchbreaks Stair access School governors Employer Access to gym Teachers Active games Government Colleagues Media Green space Age Community Motivation Family Health insurers Beliefs Knowledge/ education Bike paths Income Housework Government Self-image Abilities Gender Town planners Friends Time Shop location Mobility Architects Health professionals Media Stairs Pollution NGOs Industry Safe streets Home Street layout Environmental Sports equipment Pavements

37. Lack of physical activity • As a result of these trends… • UK: 69% of adults and 35% of children • US: 55% of adults and 31% of adolescents • - ? Data for Nigeria • … do not reach the recommended levels of physical activity. Source: ‘At least five a week’ – report from the CMO of England and Wales, 2004 and CDC 2002

38. Recommended levels of physical activity • For adults – • At least 30 minutes a day of moderate-intensity physical activity on five or more days of the week. • The 30 minutes can be made up of bouts of activity of 10 minutes or more. • For children and young people – • At least 60 minutes of moderate-intensity physical activity every day.

39. Benefits • Compared with people who do not reach the recommended levels of physical activity, active people have: • almost half the risk of dying from coronary heart disease • a 27% lower risk of stroke • a 33–50% lower risk of developing type 2 diabetes • 40–50% lower risk of colon cancer, and reduced risk of other cancers, e.g. breast cancer. • Plus, benefits for musculoskeletal health and mental health. Source: ‘At least five a week’ – report from the CMO of England and Wales, 2004

40. Increasing physical activity • No magic bullet • Many interventions will be necessary • Redesigning the environment will be more important than exhortation, doctors prescribing exercise, or gyms

41. TAKE THE STAIRS!

42. THANK YOU FOR LISTENING

43. A: BP<135 – reassess every 3 years 85 B: BP 135 -139 – high normal values 85 – 89 - reassess yearly C: 145 – 159 – Hypertension 90 – 99 (after at least three readings) ↓ Target organ damage No target organ damage CVD complications No CVD complications Diabetes No Diabetes Ten year CHD risk > 15% Ten year CHD risk < 15% ↓ ↓ TREAT OBSERVE (reassess yearly)

44. HYPERTENSION - MANAGEMENT • Non pharmacological therapy (for all) • Weight reduction\salt reduction/limit alcohol • Regular exercise • increase fruit & vegetable intake • Pharmacological therapy • Diuretic • Diuretic & B-blocker • Diuretic & ACE Inhibitors (except verapramil) • Calcium antagonist & B-blocker • Calcium antagonist & ACE In hibitor • A-blocker & B-blocker