Transcript Disease Control Priorities in Developing Countries - Inter

The Disease Control Priorities Project (www.dcp2.org)
and Chronic Disease
Presentation to the Hemispheric Meeting of the Social
Protection and Health Network of the Inter-American
Development Bank’s Regional Policy Dialogue Program,
Santiago, Chile, 30 Sept-1 Oct 2010
Philip Musgrove
Deputy Editor, Health Affairs
Note: These figures and tables are taken, sometimes with modification, from
Disease Control Priorities in Developing Countries, 2nd edn., 2006. Their
interpretation does not represent the views of Health Affairs or of Project
HOPE, of which the journal is a part, but is the sole responsibility of the author,
who was one of the editors of the Disease Control Priorities Project.
Major Causes of Death in Persons of All Ages in Low- and Middle-Income Regions
Estimated Number of Cancer Cases of All Ages, Developing Regions, 2002 (hundreds)
Estimated Numbers of People Age 20 to 79 with Diabetes, Mortality, DALYs, and Direct Medical
Costs Attributable to Diabetes, by Regions
Region
Number of people
(thousands)
2003
Prevalence (percent)
2025
2003
2025
Direct medical costs,
2003 (US$ million)
Low
High
estimate
estimate
Deaths, 2001 Disability(thousands) adjusted life
years, 2001
(thousands)
23,127
757
15,804
Developing
countries
East Asia
and the
Pacific
Europe and
Central Asia
140,849
264,405
4.5
5.9
12,304
31,363
60,762
2.6
3.9
1,368
2,656
234
4,930
25,764
33,141
7.6
9.0
2,884
5,336
51
1,375
Latin
America and
the
Caribbean
Middle East
and North
Africa
South Asia
19,026
36,064
6.0
7.8
4,592
8,676
163
2,775
10,792
23,391
6.4
7.9
2,347
4,340
31
843
46,309
94,848
5.9
7.7
840
1,589
196
4,433
7,595
16,199
2.4
2.8
273
530
82
1,448
53,337
68,345
7.8
9.2
116,365
217,760
202
4,192
194,186
332,750
5.1
6.3
128,669
240,887
959
19,996
SubSaharan
Africa
Developed
countries
World
Distribution of Deaths by Cause in Chile, 1909 and 1999
Percentage Change in Ischemic Heart Disease Death Rates
in People Age 35 to 74, 1988-98, Selected Countries
Changes in Lung Cancer Mortality at Age 35 to 44 in
the United Kingdom and France, 1950-99
Improving the Health of Populations: Lessons of Experience
Cases Relevant to Chronic Disease
Mineral fortification
With Iron in Foodstuffs
With Flouride in Salt
With Iodine in Salt
Tobacco Control
Through Tax Increases
Through Education and Behavior Change Interventions
Convincing and Probable Relations between Dietary and Lifestyle Factors and Chronic Diseases
Factors
Avoid
Smoking
Exercise
Avoid
Overweight
Eat healthy
fats
Eat fruits &
vegetables
Eat whole
grains
Limit sugar
Limit
calories
Limit
Sodium
CVD
Type 2
Diabetes
Cancer
Dental
Disease
Fracture Cataract
Birth
Defects
Obesity Metabolic Depression
Sexual
Syndrome
Dysfunction
Global CVD Burden Caused by High Blood Pressure, Cholesterol, and Bodyweight
Continuous Risks of Blood Pressure, Cholesterol, and Body Mass
and Coronary Heart Disease Risk
Number of Deaths and CVD Events Prevented by the Use of a Four-Component Medical
Regimen and CABG per 100,000 Myocardial Infarction Survivors over 10 Years, by Region
Region
Number of events prevented with fourcomponent medical regimen compared with no
therapya
IHD deaths Stroke
Myocardial Strokes
averted
deaths
infarctions prevented
averted
prevented
Number of incremental events prevented with
CABG compared with medical therapy
IHD deaths Stroke
averted
deaths
averted
Myocardial Strokes
infarctions prevented
prevented
East Asia
and the
Pacific
Europe and
Central Asia
1,900
104
4,077
209
79
11
248
22
1,990
89
3,964
179
83
1
294
7
Latin
America and
the
Caribbean
Middle East
and North
Africa
South Asia
1,913
83
4,040
118
62
4
258
18
1,908
95
4,294
118
62
1
296
22
1,930
97
4,043
122
34
2
275
30
Sub-Saharan
Africa
1,909
91
4,233
173
69
12
254
1
Use of Taxes and Subsidies to Promote Health by Type of Intervention
How Much Health Will a Million Dollars Buy?
Intervention
US$/DALY DALYs/Million US$
Preventing and treating noncommunicable disease
Taxing tobacco products
3-50
24,000-330,000
Treating AMI (heart attacks) with an inexpensive set of drugs
10-25
40,000-100,000
Treating AMI with inexpensive drugs plus streptokinase (costs and
600-750
1,300-1,600
DALYs for this intervention are in addition to what would have
occurred with inexpensive drugs only)
Treating heart attack and stroke survivors for life with a daily polypill
700-1,000
1,000-1,400
combining four or five off-patent preventive medications
Performing coronary artery bypass grafting (bypass surgery) in specific
>25,000
<40
identifiable high-risk cases—for example, disease of the left main
coronary artery (incremental to treatment with polypill)
Using bypass surgery for less severe coronary artery disease
Very high
Very small
(incremental to treatment with polypill)
Other
Detecting and treating cervical cancer
Operating a basic surgical ward at the district hospital level that
focuses on trauma, high-risk pregnancy, and other common surgically
treatable conditions
15-50
70-250
20,000-60,000
4,000-15,000