Transcript presentation

The World Health Assembly 66
World Health Editors Network
"Enter the Stadium – Democratize Knowledge – Bring it
Home"
Non-communicable Diseases -- Overview
Professor Kathryn Taubert
Chief Science Officer
World Heart Federation
Geneva
May 19, 2013
Non-Communicable Diseases (NCDs)
“Today, NCDs (mainly CV diseases, cancers,
chronic respiratory diseases & diabetes)
represent a leading threat to human health
and development. These 4 diseases are the
world’s biggest killers, causing an estimated
35 million deaths each year - 60% of all
deaths globally - with 80% in low- and middleincome countries.”
Dr Ala Alwan
Assistant Director-General
Noncommunicable Diseases
& Mental Health
World Health Organization
--circa 2010
Deaths by cause in the world
Noncommunicable diseases:
63% (36 million) of the total
deaths/year
Heart disease
Infectious diseases/
injuries:
HIV/AIDS
Tuberculosis
(48% of all NCDs)
Malaria
Total
57 M
Cancer
Other
Infectious
Diseases
Injuries
Diabetes
Other chronic diseases
(WHO, 2008 data)
Non-communicable diseases (NCDs) are
leading cause of death in the world
Global deaths by cause, all ages, 2008
20000000
57 million total deaths/yr
globally; 63% (36 million)
are from NCDs
18000000
Number of deaths
16000000
14000000
12000000
10000000
8000000
6000000
4000000
2000000
0
HIV/AIDS
Tuberculosis
Malaria
Cardiovascular
Diseases
The blue bars represent
communicable diseases
Source : WHO 2008: Global Health Observatory Data Repository
Cancers
Chronic
respiratory
diseases
The gold bars represent
NCDs
Diabetes
NCDs as a Development Issue
Ban Ki-moon
Secretary-General
United Nations
 “NCDs hit the poor and vulnerable particularly hard
and drive them deeper into poverty“
 “More than 25% of those who succumb to NCDs are
in the prime of their working lives, and the vast
majority of these individuals are in developing
countries."
 “Our collaboration is more than a public
health necessity. Noncommunicable
diseases are a threat to development."
In 2009, the World Heart Federation and
its sister federations the International
Diabetes Federation and the Union for
International Cancer Control formed the
Non‐Communicable Disease (NCD)
Alliance, joined in early 2010 by the
International Union Against
Tuberculosis and Lung Disease,
together currently representing a
network of over 2,000 civil society
organizations in more than 170
countries.
Changing the face of global health
 In September 2011, the United Nations held a high level meeting in
New York on the prevention and control of non-communicable diseases
(NCDs): only the second of its kind on a health issue in history. World
Heart Federation together with its NCD Alliance disease partners in
cancer, chronic respiratory diseases and diabetes were instrumental in
securing this meeting.
 In September 2011 a Political Declaration was signed by all member
states and now represents the NCD Targets roadmap.
 Subsequently in May 2012, the World Health Assembly adopted a global
target of a 25% reduction in premature mortality from NCDs by
2025.
Welcome to
?
Cancer
Tobacco
Hypertension
Dyslipidemia
CV disease
Obesity
Physical inactivity
Diabetes
Diabetes
Modified from Taubert
Nature Clin Pract CV Med,
2007
Poor nutrition
NCD Burden
In 2008, 80% of all deaths (29 million) from NCDs occurred
in low‐ and middle‐income countries, and a higher
proportion (48%) of the deaths in the latter countries are
premature (under the age of 70) compared to high income
countries (26%). According to WHO’s projections, the total
annual number of deaths from noncommunicable diseases
will increase to 55 million by 2030, if “business as usual”
continues.
Non Communicable Disease
A Burden particularly on the Developing World
Global NCD Action Plan 2013-2020
Final draft
Aligning with WHO targets
Global Coalitions
WHF (Cardiovascular) – IDF (Diabetes) – UICC
(Cancer) – "the Union" (Respiratory)-- working
together with WHO and the UN to put a global
focus on non-communicable diseases
Press
Governments/
Policy Makers
Winning the
war on NCDs
Public/ Civil
Society
United
Nations/
WHO
Medical/ Scientific
Community
Thank you!
PUBLIC
AWARENESS
PRESS
Working together
MEDIA
for
WAR ON
CARDIOVASCULAR
DISEASE
POLICY
POLICY MAKERS
PRIORITY
INTERNATIONAL
SUPPORT
MEDICAL/
SCIENTIFIC
COMMUNITY
SCIENTIFIC EVIDENCE
Working with the
World Health Organization (WHO):
We are the only recognized cardiovascular disease NGO
partner to the WHO.
Special consultative status is granted to NGOs which have
a special competence in, and are concerned specifically
with, only a few of the fields of activity covered by the
ECOSOC.
About us
Membership: 200 organizations from
more than 100 countries worldwide that
combines the strength of cardiology
societies and heart foundations.
Message: cardiovascular disease, which
includes heart disease and stroke, is the
number one killer worldwide causing
17.3 million deaths annually.
The majority of premature deaths can
be prevented through controlling risk
factors such as unhealthy diets, physical
inactivity and tobacco use.
Strategy and goals
Fig. 1: Results of hypothetical placebo-controlled trials of a new drug for acute myocardial
infarction.
Barratt A et al. CMAJ 2004;171:353-358
©2004 by Canadian Medical Association
Figure.
Barratt A et al. CMAJ 2004;171:353-358
©2004 by Canadian Medical Association
An estimated 36 million deaths, or 63% of the 57 million deaths that occurred
globally in 2008, were due to noncommunicable diseases, comprising mainly
cardiovascular diseases (48% of noncommunicable diseases), cancers (21%),
chronic respiratory diseases (12%) and diabetes (3.5%). These major
noncommunicable diseases share four behavioural risk factors: tobacco use,
unhealthy diet, physical inactivity and harmful use of alcohol. In 2008, 80% of all
deaths (29 million) from noncommunicable diseases occurred in low‐ and
middle‐income countries, and a higher proportion (48%) of the deaths in the
latter countries are premature (under the age of 70) compared to high income
countries (26%). According to WHO’s projections, the total annual number of
deaths from noncommunicable diseases will increase to 55 million by 2030, if
“business as usual” continues.
Absolute risk reduction, also termed risk difference, is the difference between the absolute
risk of an event in the intervention group and the absolute risk in the control group.
Relative risk, also known as risk ratio, is the risk of an event in the experimental group
divided by that in the control group.
In a trial of 441 patients at risk of developing pressure ulcers, patients were
randomised to receive a sheepskin mattress overlay (intervention group) or usual
treatment (control group) during their hospital stay.
Absolute risk:
10%
17%
The absolute risk reduction can then be calculated by subtracting the proportion
of patients with ulcers in the sheepskin group from that in the control group.
37/223 minus 21/218 = .07 (70%)
In the trial, 10% of patients in the sheepskin group developed ulcers compared to
17% in the control group. So the risk of getting ulcers with a sheepskin overlay was
0.58 of that in the control group.
21/218 divided by 37/223 = .58 Relative risk reduction – 1-.58 = 42%
Raising the priority of cardiovascular health on
the global health agenda -- UN General
Assembly Resolution on NCDs
♥ UN Millennium Development Goals drive global development
agenda
♥ The NCD Alliance mobilized civil society to campaign for a United
Nations (UN) Summit on NCDs
♥ In May 2010, the UN voted unanimously for passage of resolution
titled "Prevention and control of non-communicable diseases"
whereby the UN convenes a High Level Summit (attended by
heads of state or their designee) &the Sec'y General prepares a
global
report on
NCDs.
This
Summit
held
Sept. 19-20, 2011, in
NYC. A political declaration/outcomes
document was approved. Called for
national NCD plans by 2013 with action
items e.g., goals for elimination
transfats, reduction in consumption of
Non-Communicable Diseases (NCDs)
“These diseases are preventable. Up to 80%
of heart disease, stroke, and type 2 diabetes
and over a third of cancers could be
prevented by eliminating shared risk factors,
mainly tobacco use, unhealthy diet, physical
inactivity and the harmful use of alcohol.”
Dr Ala Alwan
Tobacco
use
30%
Diabetes/
Obesity
0%
Raised
blood
pressure
25%
Multidrug
Therapy
50%
Essential
Med/Tech
80%
25 by 25
Fat intake
15%
Physical
inactivity
10%
Salt/
sodium
intake
30%
Alcohol
10%