Chronic respiratory diseases: burden, population and interventions, focus on LMIC

1. Chronic respiratory diseases: burden, population and interventions, focus on LMIC (Dr. Eugene Zheleznyakov, Technical Officer, Chronic Disease Prevention and Management, WHO, Geneva)

2. Did you know?? 4 000 000PEOPLE DIED FROMCHRONIC RESPIRATORY DISEASES IN 2005

3. Chronic respiratory diseases worldwide Main NCDs include: • Cardiovascular diseases mainly heart disease and stroke • Cancer • Chronic respiratory diseases • Diabetes

4. Projected disease deaths and burden. 2005 Preventing Chronic Diseases, a vital investment, WHO, 2005 Main causes of global burden of disease (DALYs) Main causes of death Communicable diseases Maternal/perinatal Nutrional deficiencies 7% Cardiovascular Cancer 4% CRD Diabetes Other chronic diseases Injuries

5. Chronic respiratory diseases worldwide Hundreds of millions of people have chronic respiratory diseases • including 300 million people with • asthma • 210 million people with chronic obstructive pulmonary disease (COPD) • Millions of people with allergic rhinitis, sleep apnoea syndrome and other chronic respiratory diseases

6. Chronic Respiratory Diseases

7. 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/ 2.2 0.8 Bronchus /Trachea Cancer Asthma 0.4 1.0 Total 16.8 11.9 *DALYs = Disability-Adjusted Life-Years Source: World Health Report 2003

8. 4 million people die each year from CRD And in 2030: COPD: 4th cause of death (Plos Med 2006) Tobacco > 8 million deaths (Plos Med 2006) Biomass fuel combustion > 10 million deaths(Ezzatti, Science 2005) > 50% of the world population will be allergic Chronic respiratory diseases

9. Disability Adjusted Life Years One DALY: one lost year of “healthy” life DALY = YLD + YLL COPD onset expected death death 55 65 75 YLD YLL 50 Years of Life with Disability Years of Life Lost What are DALYs? age (years)

10. Increasing Burden of Diseases and Injuries: Change in Rank Order of DALYs* *DALYs = Disability-Adjusted Life-Years Source: WHO Evidence, Information and Policy, 2005 *DALYs: Disability Adjusted Life Years

11. Age-standardized disability-adjusted life year (DALY) rates from respiratory diseases by country (per 100,000) Canuckguy et al. 2009

12. WHO global approach to control Chronic Respiratory Diseases

15. The aim of the WHO chronic respiratory diseases programme as a part of NCD programme is to support member states in their efforts to reduce the toll of morbidity, disability and premature mortality related to chronic respiratory diseases, and specifically, asthma and chronic obstructive pulmonary disease (COPD). Objectives: Better surveillance to map the magnitude of chronic respiratory diseases and analyze their determinants with particular reference to poor and disadvantaged populations, and to monitor future trends. Primary prevention to reduce the level of exposure of individuals and populations to common risk factors, particularly tobacco, poor nutrition, frequent lower respiratory infections during childhood, and environmental air pollution (indoor, outdoor, and occupational). Secondary and tertiary prevention to strengthen health care for people with chronic respiratory diseases by identifying cost-effective interventions, upgrading standards and accessibility of care at different levels of the health care system.

16. May 2010

20. Framework Convention on Tobacco Control (FCTC) As for 1As for 17 December 2004: 47 countries have ratified the treaAs for 17 December 2004: 47 countries have ratified the treaty. On 27 February 2005: the FCTC has entered into force and has become an International law. ty. On 27 February 2005: the FCTC hasAs for 17 December 2004: 47 countries have ratified the treaty. On 27 February 2005: the FCTC has entered into force and has become an International law. entered into force and has become an International law. 7 December 2004: 47 countries have ratified the treaty. On 27 February 2005: the FCTC has entered into force and has become an International law. Today the FCTC has 140 parties (16 November 2006)

21.  Reducing NCD risk factors

22.  Reducing NCD risk factors

23.  Reducing NCD risk factors

24. Source: World Health Report, 2002

25. Source: World Health Report, 2002

26. The relative importance of Tobacco Smoke and other risk factors relevant for COPD Opposite patterns in different geographic areas EUROPE versus AFRICA Source: World Health Report 2002

27. EUROPE Disease burden (DALYs) in 2000 attributable to selected risk factors Blood pressure Tobacco Tobacco Alcohol Cholesterol High Body Mass Index Fruit and vegetable intake Physical inactivity Illicit drugs Lead exposure Unsafe sex Iron deficiency Occupational risk factors for injury Urban air pollution Urban air pollution Childhood sexual abuse Underweight Unsafe water, sanitation, and hygiene Indoor smoke from solid fuels Number of Disability-Adjusted Life Years (000s) 0 5000 10000 15000 20000

28. Unsafe sex Underweight Unsafe water, sanitation, and hygiene Vitamin A deficiency Zinc deficiency Indoor pollution Indoor smoke from solid fuels Iron deficiency Alcohol Blood pressure Lack of contraception Tobacco Tobacco Cholesterol Unsafe health care injections Global climate change Occupational risk factors for injury Fruit and vegetable intake 0 10000 20000 30000 40000 50000 60000 70000 Number of Disability-Adjusted Life Years (000s) AFRICA Disease burden (DALYs) in 2000 attributable to selected risk factors Lead exposure

29. Multisectoral collaboration Multilateral Bilateral Agencies Educational Sector Professional Associations Communities, churches, religious leaders Patient Groups Private sector, media CRD and public health experts Related Ministries NGOs

30. Global Alliance against Chronic Respiratory Diseases Web site: www.who.int/gard E-mail: gard@who.int