Transcript Time to Act - World Heart Federation

Time to Act
The Wold Heart Federation
Advocacy Toolkit
Content
• The background -a look at the current NCDs
and CVD situation
• Behind CVD -the risk factors
• CVD and NCDs-a neglected development issue
• We can act -the World Heart Federation’s and
the world’s global response
The background
A look at the current NCDs and CVD situation
« NCDs are ranked as the third most likely risk
to come true and the fourth most severe in
its impact for 2009 »
The World Economic Forum
Global Burden of Disease:
NCDs cause over 50% of deaths worldwide
Source: WHO Global Burden of Disease Report Update 2004, Geneva 2008
Note: NCDs: CVD, cancer, chronic respiratory, diabetes
Global Burden of Disease:
NCDs responsible for high rates of premature mortality
(deaths per 1000 in adults between 15-59 years)
Source: WHO Global Burden of Disease Report Update 2004, Geneva 2008
NCDs: Leading cause of male deaths worldwide
Projected main causes of death in males by WHO
region, all ages, 2005
1200
WHO region
Age-standardized death rates per 100,000
1000
800
600
400
200
0
Africa
Americas
South-East Asia
Europe
Eastern
Mediterranean
Western Pacific
WHO region
Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies
Chronic diseases
Injuries
Source : «Preventing Chronic Diseases: A Vital Investment», WHO, 2005
World
NCDs: Leading cause of female deaths worldwide
Projected main causes of death in females by WHO
region, all ages, 2005
1200
WHO region
Age-standardized death rates per 100,000
1000
800
600
400
200
0
Africa
Americas
South-East Asia
Europe
Eastern
Mediterranean
Western Pacific
World
WHO region
Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies
Chronic diseases
Injuries
Source : «Preventing Chronic Diseases: A Vital Investment», WHO, 2005
Among NCDs, CVD is leading cause of death
worldwide
Estimated global deaths by cause, all ages, 2005
20000000
C a rdio v a s c ula r
dis e a s e s
18000000
16000000
14000000
12000000
10000000
8000000
C a nc e r
6000000
C hro nic re s pira t o ry
dis e a s e s
4000000
H IV / A ID S
2000000
T ube rc ulo s is
M a la ria
0
Source : WHO 2005: «Preventing Chronic Diseases: A Vital Investment»
D ia be t e s
Burden of CVD
Men and women by region
Number of CVD deaths in millions
10
8
6
4
2
0
EURO
EMRO
Source: WHO Country Profiles, 2002, www.who.int
AFRO
PAHO
SEARO
WPRO
A higher % of CVD deaths occur between 35
and 64 years of age in countries with
developing economies
100%
90%
31
80%
32
46
70%
60%
73
75+
70
50%
34
40%
10%
0%
23
18
22
18
17
8
8
10
3
1
3
3
Portugal
(10%)
USA
(12%)
Brazil
(28%)
India
(35%)
Source : “A Race Against Time”, The Earth Institute, Colombia University, Stephen Leeder, 2004
45-54
35-44
12
6
3
1
65-74
55-64
26
30%
20%
27
6
S. Africa
(41%)
Disease burden of CVD and NCDs falls heavily
on those between the ages of 15 & 69 in lowand middle-income countries (2005 figures)
Percentage
80
70
All NCDs
60
CVD
50
40
30
20
10
0
% of deaths accounted for by those
aged 15-69
% of DALYs accounted for by
those aged 15-69
Disease category (m illions)
DALY (Disability Adjusted Life Year)= The sum of years of potential life lost due to premature
mortality and the years of productive life lost due to disability.
Source : “Public Policy and the Challenge of Chronic Noncommunicable Diseases”, World Bank, 2007
« The NCDs epidemic threathens to
overwhelm health systems »
WHO, ECOSOC meeting 2009
« The costs of NCDS create a poverty trap (…)
The epidemic of NCDs slows economic
growth »
WHO, ECOSOC meeting 2009
There is a « bitter irony in promoting health
as a poverty reduction strategy at a time
when the costs of health care themselves
can be a cause of poverty »
Her Royal Highness Princess Muna Al-Hussein, Ecosoc
Meeting 2009
NCDs macro-economic impact
Lost National Income
Lost national income from
premature deaths due to heart
disease, stroke and diabetes
2005
2006-2015 (cumulative)
Lost national income (billions)
Lost national income
(billions)
Brazil
3
49
China
18
558
India
9
237
0.4
8
Pakistan
1
31
Russian Federation
11
303
Tanzania
0.1
3
Countries
Nigeria
WHO: "Heart disease, stroke and diabetes alone are estimated to
reduce GDP between 1 to 5% per year in developing countries
experiencing rapid economic growth"
Source: WHO Chronic Disease Report, 2005
« In Oman, it is estimated that there will be a 210%
increase in the demand for health care by 2025, and
treatment for cardiovascular diseases alone will
account for 21% of total health care expenditures »
WHO, ECOSOC Meeting 2009
« Conservatives estimates in Brazil, China, India,
Mexico, and South Africa indicate that each year at
leat 21 million years of future productive life are lost
because of CVD »
WHO, ECOSOC Meeting 2009
CVD macro-economic impact
• CVD is expensive for the world. It costs the European Union
US$ 219 billion (€169 billion). The most updated data from
USA shows that CVD costs nearly US$ 403 billion in direct
and indirect costs
• By comparison, the estimated cost of all cancers is US$ 189
billion (€146.19 billion) and HIV US$ 28 billion (€22.4
billion)
• The economic burden is no longer confined to the affluent,
industrial world
• In developing countries CVD disproportionately affect the
working-age adults from lower socio-economic groups
• In 1995, the costs of tobacco-related disease accounted for
1.5% of GDP in China, and obesity-related costs were
equivalent to 1.1% of the GDP
Source: WHO, Hu & Mao, 2002; Leeder et. Al. 2004
NCDs: Projections
Death trends (2006-2015)
2005
Total
deaths
(millions)
NCD
deaths
(millions)
NCD
deaths
(millions)
Trend: Death
from infectious
disease
Trend: Death
from NCD
Africa
10.8
2.5
28
+6%
+27%
Americas
6.2
4.8
53
-8%
+17%
Eastern
Mediterranean
4.3
2.2
25
-10%
+25%
Europe
9.8
8.5
88
+7%
+4%
South-East Asia
14.7
8.0
89
-16%
+21%
Western Pacific
12.4
9.7
105
+1
+20%
Total
58.2
35.7
388
-3%
+17%
WHO projects that over the next 10 years, the largest increase in
deaths from cardiovascular disease, cancer, respiratory disease and
diabetes will occur in developing countries.
(WHO Chronic Disease Report, 2005)
Geographical
regions (WHO
classification)
2006-2015 (cumulative)
NCDs: Projections
Projected Deaths in 2015 and 2030
30
Intentional injuries
Other unintentional
Road traffic accidents
Deaths (millions)
25
Other NCD
20
Cancers
15
CVD
CVD
10
Mat//peri/nutritional
5
Other infectious
HIV, TB, malaria
0
2004
2015
2030
High income
2004
2015
2030
Middle income
2004
2015
2030
Low income
CVD: Projections
• Contact WHO
Behind CVD
The risk factors
« Multiple studies confirm the rise of NCDs
and risk factors around the world. But the
rise in risk factors is only partly explained
by a change in personal behaviours.
Personal behaviours are not only a personal
choice. Much larger forces are at play here »
WHO, ECOSOC Meeting, July 2009
NCDs: Risk factors
4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco
Use
Cardiovascular
Diabetes
Cancer
Chronic
Respiratory
Unhealthy
diets
Physical
Inactivity
Harmful
Use of
Alcohol
NCDs: Risk factors’ impact
Tobacco: Behaviours associated with risk factors are
costly
Monthly household expenditure of tobacco vs. nutritious food
among street children in Mumbai (India)
Avg. Monthly Exp in INR
200
180
160
140
120
100
80
60
40
20
0
186.1
173.9
137.4
119
109.8
61.9
48.5
Source: Path Canada 2003
Items Consumed
43.6
CVD: Risk factors
6 of top 10 risk factors in low- and middle- income
countries lead to CVD
Risk factor for CVD
Source : “Global Burden of Disease and Risk Factors”, Lopez and others, Oxford University Press, 2006
CVD: Risk factors
Number of adults living with hypertension in millions
Projected progression of hypertension
1600
1200
800
400
0
2000
Source: International Society of Hypertension
2025
CVD: Risk factors
Trends in Hypertension
• More than 20 million people have hypertension in Africa, with
a prevalence ranging from 25% to 35% in adults aged 25-64
years*
• In China, 18.8% above 18 of the population suffers from high
blood pressure**
• In England, 32.1 % of people above 16 suffer from high blood
pressure***, and 2 out of 3 people above 65 suffer from it as
well****
*WHO Regional Office for Africa (WHO/AFRO), The Health of the People: The African Regional Health
Report (2006). WHO Geneva 2006
**WHO Global Infobase, 2002 data for China
***WHO Global Infobase, 2003 data for England
****NHS, Health Survey for England, 2005
CVD: Risk factors
Trends in Tobacco
• 20.4% of Australian women 26.2% of men above 18 and
smoke*
• In France, 26.5 % of women and 33.3% of men between 12
and 75 are current users of tobacco**
• In Chile, 43.6% of males and 31.8% of females above 15 are
current users of cigarettes***
• In Indonesia, 63.5% of males are daily users of tobacco****
*,**,***,**** WHO Global InfoBase, countries surveys from various years
CVD: Risk factors
Tobacco use on the rise in developing countries
« When money is tight, the first thing that
drop out of the diet are usually healthy
foods, like fruits, vegetables, and lean
sources of protein, which are nearly always
more expensive.
Processed foods (…) become the cheapest
way to fill a hungry stomach. This is the
type of diet linked to the rise of chronic
diseases. »
Dr. Margaret Chan, ECOSOC Meeting, July 2009
CVD: Risk factors:
Trends in Obesity
• Worldwide, 30% of women and 40% of men are now
overweight and 27% of women and 24% of men are obese*
• In China, 18.8% of women and 19.1% of men above 18 are
overweight or obese**
• In South Africa, 56.2% of women 29.1% of men above 15
and are overweight or obese***
• In the US, 31.1 % of males and 33.2% of females above 20
are obese****
• In 2007, an estimated 22 million children under the age of 5
years were overweight throughout the world*****
• More than 75% of overweight and obese children live in lowand middle-income countries******
* Balkau B, et al. A Study of Waist Circumference, Cardiovascular Disease, and Diabetes Mellitus in 168 000 Primary Care Patients in 63
Countries. Circulation, 2007;116:1942-1951
**,***,****,***** WHO Global InfoBase, countries surveys from various years
*****; ******WHO http://www.who.int/dietphysicalactivity/childhood/en/
CVD: Risk factors
Childhood obesity trends around the world
CVD: Risk factors
Projected prevalence of overweight and obese school
children by region today and in 2010
100
80
60
46.4%
41.7%
38.2%
40
27.7%
23.5%
20
0
27.2%
25.5%
22.9%
10.6%
Americas
Eastern Med
Europe
South East Asia
Source: Wang Y, Lobstein T, Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity. 2006; 1:11-25
12%
West Pacific
CVD and NCDs:
A neglected development issue
« Non-communicable diseases are responsible for twice the
number of deaths caused by infectious diseases yet receive
only a tiny fraction of national and development heath
funding »
Cherie Blair, ECOSOC Meeting, July 2009
« There does not seem to be a consensus among development
agencies on the need to include non-communicable
diseases (…) in global discussions on development »
Dr.Ala Alwan, ECOSOC Meeting, July 2009
« The greatest burden of preventable death and disability in
both rich and poor countries is being caused by the very
conditions that are receiving least Official Development
Assistance »
Her Royal Highness Princess Muna Al-Hussein, ECOSOC Meeting, July 2009
Donors are not responding to requests for technical
assistance
Official Development Assistance for Health
(2006, in US$ Billions, total is US$21 billion)
$4.75
STD & HIV/AIDS Control
$2.10
Infectious Disease Control
$1.93
Health Policy/Management
$1.80
Basic Health Care
$1.30
Reproductive Health Care
$0.70
Basic Health Infrastructure
$0.60
Medical Research
Medical Services
$0.20
Family Planning
$0.20
Basic Nutrition
$0.10
Health Training
$0.08
Health Education
$0.00
$2.70
Water supply/sanitation-large systems
$2.00
Water Policy/Management
$1.00
Basic drinking water supply & sanitation
River development
Waste management/disposal
Water resources protection
Water Education/Training
$0.30
$0.20
$0.10
$0.00
* ODA = Official Development Assistance provided by 24 OECD/DAC donor countries, as well as the EC
NCDs
Worldwide, current investement in CVD and
other chronic diseases is outrageoulsy low…
• The Global Fund for HIV/AIDS, TB and Malaria total pledges paid
to date: USD 11.8 billion
• Since 2000, the World Bank has so far made available nearly US$
1.2 billion to fund HIV/AIDS programmes in Africa
• In 2006, the International Finance Facility for Immunization
launched a bond that raised US$ 1 billion
• Total contributions to GAVI for the year 2007 amounted to US$
786 million
• Half of the US$ 1.8 billion allocated to health programmes by
USAID in 2003 were for HIV/AIDS and infectious diseases.
Another 45% were for maternal health, child survival and
population control.
• For the 2008-2009 biennum, the WHO will allocate almost US$
900 million to communicable disease whereas the budget
allocated to non-communicable disease barely reaches US$ 160
million.
…but progress is being made slowly
• Despite the apparent imbalance in the WHO budget, the funding
for non-communicable disease for the 2008-2009 biennium
represents a 44% increase from the 2006-2007 budget
• It now represents 4% of WHO total budget (total budget is
roughly US$ 3.3 billion)
• Tobacco control, one of CVD main risk factors, is getting more and
more funds: the Bloomberg initiative had an endowment of US$
125 million, directed at low- and middle-income countries. US$
250 million have recently been added to this pledge
• The Bill and Melinda Gates Foundation is now getting involved in
tobacco control, by pledging US$ 125 million
• The Alliance for a Healthier Generation (USA) has so far received
US$ 28 million from the Robert Johnson Foundation for its Healthy
Schools programme
• Ovations is contributing US$ 15 million to create centres to
counter chronic disease in developing countries
• The UK Medical Research Council supports the OxHA Grand
Challenges in Chronic Non-Communicable Disease with a £6
million grant
• In 2007, IDF received a multi-year grant of US$ 10 million for it
BRIDGES programme which provides grants to fund translational
research projects in diabetes prevention
« We must make the prevention and control of
non-communicable diseases and
improvement of maternal health top
priorities of the development agenda (…).
Both are begging for more attention »
Dr. Margaret Chan, ECOSOC Meeting, July 2009
« I want to highlight the glaring omission of
non-communicable diseases in the MDGs
(…). This anomaly should be corrected »
Dr. Leslie Ramsammy, ECOSOC Meeting, July 2009
A neglected development issue:
CVD and NCDs are not included in the United Nations
Millennium Development Goals
1. Eradicate poverty and hunger
2. Achieve primary universal education
3. Promote gender equality and empower
women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other
diseases
7. Ensure environmental sustainability
8. Develop a global partnership for
development
Cardiovascular and
other chronic diseases
must be included
We can act
The world’s and the World Heart Federation’s
global response
« We know the major steps that need to be
taken to reverse this tidal wave of noncommunicable diseases »
Cherie Blair, ECOSOC Meeting, July 2009
« Control of non-communicable disease (is a)
fully ready and mature area for efficient
interventions with a huge return »
Margaret Chan, ECOSOC Meeting, July 2009
NCDs:
The Global Response: example at the WHO level
NCDs: Fighting risk factors
Selected Multi-sectoral Approaches to Reduce Tobacco
Use
• Increase tax rates for tobacco products
• Enact and enforce completely smoke-free environments
• Make tobacco cessation advice available as part of primary
health care
• Require effective package warning labels
• Enact and enforce legislation to ban any form of direct and
indirect tobacco advertising, promotion and sponsorship
• Obtain free media coverage of anti-tobacco activities
• Implement counter-tobacco advertising
• Strengthen tax administration to reduce illicit trade in tobacco
products
For more information please refer to the Framework Convention on Tobacco Control
NCDs: Fighting risk factors
Selected Multi-sectoral Approaches to Reduce
Unhealthy Diet
• Reduce trans fatty acids and salt
• Restrict availability of energy dense foods and high calorie nonalcoholic beverages
• Increase availability of healthier foods including fruits and
vegetables
• Practice of responsible marketing to reduce impact of unhealthy
foods to children
• Make healthy options available and affordable
• Provide simple, clear and consistent food labels that are
consumer friendly
• Reshape industry to introduce new products with better
nutritional value
For more information please refer to the Global Strategy on Diet Physical Activity and Health
CVD:
The World Heart Federation’s answer
Together with its members, the WHF achieves its mission through:
•
•
•
•
Awareness Building
Advocacy
Demonstration Projects
Sharing Science/Building Capacity
CVD:
World Heart Federation’s Activities
Awareness Building
• World Heart Day
• Go Red for Women
• Children/Adolescents:
- Sesame Workshop
- Youth leadership
Advocacy
• Framework
Convention on
Tobacco Control
• WHO Global
Strategy on Diet,
Physical Activity &
Health
Applied
Research
• RF/RHD secondary
prevention project
in South
Pacific/Africa
• Plaza Sésamo
Colombia/Youth
advocacy
• CVD in Millennium
Development
Goals
• China Bridging the
Gap
• Wellness in the
workplace
• Grenada Heart
Project
• The Polypill
• Healthy Active
Youth programme
Sharing
Science
Scientific Meetings
• World Congress of
Cardiology
• Bi-annual
Continental Society
Congresses
Continuing
Education
• Fellowships
Journals
• Nature: Clinical
Practice CV Médicine
• CVD Prevention &
Control
Building capacity
CVD:
Working with members to fight the disease
250
200
150
195
Associate International
165
Associate National
National - Foundations
National - Societies
100
Continental
50
0
2002
2008
WHF’s membership in 2002 and today
CVD:
Working with members to fight the disease
90
80
70
60
Assoc International
50
Assoc National
Nat'l foundations
40
Nat'l societies
30
Continental
20
10
0
Afr 02
Afr
act.
Amrs Amrs
02
act.
AP 02
AP
act.
Eur 02 Eur
act.
WHF’s membership by region in 2002 and today
CVD:
Working with members to fight the disease
Member National Societies
Algerian Society of Cardiology
Finnish Cardiac Society
Argentine Society of Cardiology
French Society of Cardiology
Lebanese Society of Cardiology and
Cardiac Surgery
Society of Cardiology of the
Russian Federation
The Cardiac Society of Australia & New
Zealand
Georgian Association of Cardiology
Libyan Cardiac Society
San Marino Society of Cardiology
German Cardiac Society
Lithuanian Society of Cardiology
Saudi Heart Association
Austrian Society of Cardiology
Macau Association of Cardiology
Bangladesh Cardiac Society
Ghana Society of Hypertension and
Cardiology
Macedonia Society of Cardiology
Society of Cardiology of Serbia
and Montenegro
Belarusian Scientific Society of Cardiologists
Hellenic Cardiological Society
National Heart Association of Malaysia
Singapore Cardiac Society
Belgian Society of Cardiology
Guatemala Association of Cardiology
Mexican Society of Cardiology
Slovak Society of Cardiology
Bolivian Society of Cardiology
Honduras Society of Cardiology
Moldavian Society of Cardiology
Slovenian Society of Cardiology
Association of Cardiologists of Bosnia &
Herzegovina
Hong Kong College of Cardiology
Moroccan Society of Cardiology
Hungarian Society of Cardiology
The South African Heart
Association
Brazilian Society of Cardiology
Cardiological Society of India
Cardiac Society of Myanmar Medical
Association
Bulgarian Society of Cardiology
Indonesian Heart Association
Cardiac Society of Nepal
Canadian Cardiovascular Society
Iranian Heart Association
The Netherlands Society of Cardiology
Chilean Society of Cardiology & Cardiovascular
Surgery
Iraqi Cardio-Thoracic Society
Nicaraguan Society of Cardiology
Irish Cardiac Society
Nigerian Cardiac Society
Israel Heart Society
Norwegian Society of Cardiology
Italian Federation of Cardiology
Pakistan Cardiac Society
Japanese Circulation Society
Society of Cardiology of Panama
Jordan Cardiac Society
Paraguayan Society of Cardiology
Peruvian Society of Cardiology
Czech Society of Cardiology
Association of Cardiologists of
Kazakhstan
Danish Society of Cardiology
Kenya Cardiac Society
Polish Cardiac Society
Dominican Society of Cardiology
The Korean Society of Circulation
Portuguese Society of Cardiology
Ecuadorian Society of Cardiology
Association of Doctors of Internal
Medicine of Kyrgyz Republic
Latvian Society of Cardiology
Puerto Rican Society of Cardiology
Chinese Society of Cardiology
Colombian Society of Cardiology
Croatian Cardiac Society
Cuban Society of Cardiology
Cyprus Society of Cardiology
Egyptian Society of Cardiology
Society of Cardiology of El Salvador
Philippine Heart Association
Romanian Society of Cardiology
Spanish Society of Cardiology
Sri Lanka Heart Association
Swedish Society of Cardiology
Swiss Society of Cardiology
Syrian Cardiovascular Association
Taiwan Society of Cardiology
The Heart Association of Thailand
Turkish Society of Cardiology
Ukrainian Society of Cardiology
Emirates Cardiac Society
British Cardiovascular Society
American College of Cardiology
Uruguayan Society of Cardiology
Venezuelan Society of Cardiology
Vietnam National Heart
Association
CVD:
Working with members to fight the disease
Member National Heart Foundations
Argentine Heart Foundation
National Heart Foundation of Australia
Austrian Heart Foundation
National Heart Foundation of Bangladesh
Heart Foundation of Barbados
Belgian Heart League
Foundation of Health and Heart (Bosnia and
Herzegovina)
Brazilian Heart Foundation (FUNCOR)
Heart And Stroke Foundation of Canada
Chilean Heart Foundation
Un Coeur pour la Vie (Congo Brazzaville)
Cyprus Heart Foundation
Healthy Nutrition Forum (Czech Republic)
Danish Heart Foundation
Dominican Heart Foundation
Ecuadorian Foundation of Cardiology
Estonian Heart Association
Finnish Heart Association
Georgian Heart Foundation
German Heart Foundation
Ghanaian Heart Foundation
Hellenic Heart Foundation (Greece)
Hong Kong Heart Foundation
Hungarian National Heart Foundation
Icelandic Heart Association
All India Heart Foundation
Heart Foundation of Indonesia
Irish Heart Foundation
Italian Heart Foundation
The Heart Foundation of Jamaica
Japan Heart Foundation
Kenya Heart Foundation
Kuwait Heart Foundation
Lithuanian Heart Association
Macau Heart Foundation
The Heart Foundation of Malaysia
Mauritius Heart Foundation
Nepal Heart Foundation
Netherlands Heart Foundation
The National Heart Foundation of New Zealand
Nigerian Heart Foundation
Norwegian Council On Cardiovascular Disease
Pakistan Heart Foundation
Cardiological Foundation of Panama
National Heart Foundation of Papua New Guinea
Paraguayan Heart Foundation
Heart Foundation of the Philippines
Portuguese Heart Foundation
Foundation for Cardiac Assistance (Romania)
Serbian Heart Foundation
Seychelles Heart and Stroke Foundation
Singapore Heart Foundation
Slovak League Heart to Heart
Slovenian Heart Foundation
Heart and Stroke Foundation South Africa
Spanish Heart Foundation
Swedish Heart Lung Foundation
Swiss Heart Foundation
Taiwan Heart Foundation
The Heart Foundation of Thailand
Turkish Heart Foundation
British Heart Foundation
American Heart Association
Venezuelan Heart Foundation
CVD:
Leveraging Partnerships
International
Organizations
NGOs/Not for
Profit
Associations
Corporate
Partners/Major
Sponsors
• Quote by WHF