Transcript Chronic Disease – Management Priorities in the 21st Century

Chronic Disease – Management
Priorities in the 21st Century
V.K. Barbiero, PhD, MHS
George Washington University
Department of Global Health
Setting the Stage…
 Remember…averages
squat…
mean
Chronic Diseases
What Are Chronic Diseases
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Cardiovascular (heart disease) (hypertension)
Cerebrovascular (stroke)
Cancer
Chronic Respiratory Disease
Diabetes
Mental disorders
Oral disease
Bone and joint
Genetic disorders
Characteristics of Chronic Diseases
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Take time to become fully established
Have origins at young ages
Required long, systematic and often expensive
approaches to treatment
Require integration with responses to acute,
infectious diseases
Many opportunities for prevention
They are the leading cause of death in all
regions except Africa
Eight Myths of Chronic Diseases
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Wait until infectious diseases are controlled
Economic growth will improve all health
conditions
Chronic diseases affect only the affluent
Chronic diseases are diseases of the elderly
Chronic diseases result from individual behaviors
Benefits of CD control are for individuals only
ID models apply to chronic diseases
Chronic diseases should only be addressed in the
health sector
Source: Merson, et. al., 2005
The Demographic Transition
The Epidemiologic Transition
~2005
Source: Omran, A.R., 1971. The Epidemiologic Transition.
The Nutrition Transition
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Pre-processed foods
More food of animal origin
Fall in cereal and fiber intake
More sugar added to food
More alcohol
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Urbanization
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Source: Popkin, BM, 2001. Journal of Nutrition; 131:871S-873S, 2001)
Pathways of the Nutrition Transition
Prevalence of Overweight (BMI >25) of
Women by Income Strata
Prevalence (%) of BMI >25
80
70
60
50
2005
2010
2015
40
30
20
10
0
Source: WHO, 2005
Low Income Lower Middle Upper Middle High Income
The Urban Transition
2008
World 50% Urban
Four Stages of The Health Transition
CVD = Cardiovascular disease; PVD = peripheral vascular disease
Ghana’s Days of Healthy Live Lost
Undernutrition
DD, ARI
CHILDREN
Measles other
Preventable
Non Preventable
Childhood Deaths
Non
Preventable
Adult Deaths
Preventable
Adult Deaths
ADULTS
Source: Merson, et. al., 2005
Malaria
Disability-Death Model
The Ideal
PYLLs, HeaLYs, QALYys, DALYs
Early Deaths
2007 – Death/Disability
2025 – Disability/Death
Birth
24-36
Months
Continuing
Early Deaths
Disability
Death
Mortality
Death
High Case
Fatality
90 Yrs
Population/Family Planning the Development
Imperative
8
TOTAL
Billions of People
7
LDC
DC
6
5
4
3
2
1
0
1950
1960
1970
1980
1990
2000
2010
2020
Pyramids Tell the Tale…
China – 2000 & 2050
Population = 1.42B
Pyramids Tell the Tale…
Nigeria – 2000 & 2050
Population = 307M
Chronic Diseases - Fact Sheet
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35 million will die from chronic diseases in 2005
More people die from chronic diseases than infectious
diseases worldwide
 60% of all deaths are from chronic diseases
80% of chronic disease deaths occur in mid-low income
countries
12 million die of heart attacks annually
50% of deaths are women
> 1 billion adults are overweight worldwide – 30% obese
Behavioral interventions are effective
Global Chronic Disease Profile
Total Deaths 2005
~58 Million
Source: WHO, 2006
Estimated Causes of Death Worldwide
Violence/Other
9%
Injuries
9%
Diabetes
2%
COPD
7%
Comm
30%
Total Deaths 2005
~58 Million
Cancer
13%
CVD
30%
Comm
CVD
Source: WHO, 2002
Cancer
COPD
Diabetes
Injuries
Violence/Other
Projections of Future Deaths
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There will be about 64 million deaths in 2015…
 17 million from communicable diseases
 41 million from chronic diseases
 ~6 million from injuries
 CVD and stroke will remain highest with ~20
million
Source: WHO, 2002
Estimated DALYs By Condition
Diabetes
1%
Violence/Other
28%
Comm
39%
Injuries
13%
COPD
4%
Comm
CVD
Source: WHO, 2002
Cancer
CVD
10%
Cancer
5%
COPD Injuries
Violence/Other
Diabetes
The Double Burden for the Poor…
Age Standardized Death Rates
Per 100,000
Estimated Causes of Death by Income 2005
700
600
500
400
300
200
100
0
Low
L/M
U/Mid
Income Income Income
Communicable
High
Chronic
Source: WHO, 2002, vkb/extrapolated from World Bank graph
World
Injuries
Estimated DALYs by Income
16000
14000
12000
10000
8000
6000
4000
2000
0
Low
Middle
Comm
Chronic
High
Injuries
Source: WHO, 2002, vkb/extrapolated from World Bank graph
World
Elements & Progression of Chronic Diseases
Underlying
Social &
Environmental
Determinants
Modifiable
Risk Factors
Diet
Activity
Smoking
Urbanization
&
Aging
Population
Non-Modifiable
Risk Factors
Age
Heredity
Source: vkb adapted from WHO, 2002
Immediate
Risk
Factors
Main
Chronic
Diseases
Blood Pressure
High Glucose
Abdominal Fat
Overweight
Obesity
Heart Disease
Stroke
Cancer
COPD
Diabetes
No Quick Fixes…No Magic Bullets…
Preventing and Managing Chronic Disease
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Health Promotion (to shift distribution of risks)
Specific Prevention Programs
 Diet, smoking, exercise
 Environmental and Occupational Exposures
 e.g. Sexual Health (AIDS, HPV, etc)
 Retooling Health Service Programs
‘Health Impact’ of ‘Non-Health Policy’
 Food Safety
 Agriculture/Trade
 Urban Planning
Preventing and Managing Chronic Disease
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WHAT TO DO IS THE EASY PART…
HOW TO DO IT IS ANOTHER
STORY…
Policy to Action
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Talk is free
Ink is cheap
Action takes a lot of money, time,
commitment and effort…
Lessons to Date…
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HIV/AIDS Prevention, Care and Treatment
Insurance Schemes and Tiered pricing
Training and Task Shifting
 Level of training, brain drain
DOTS and TB
Diagnosis and treatment?
Prevention…?..blah, blah, blah…
 do we know?...witness USA’s BMI…
Facility care, HBC, palliative care?
Conclusions
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Chronic disease epidemiology is a worldwide
issue
We need more thought and demonstration
interventions on this issue
AIDS requires chronic disease
management…what lessons can we learn?
Double and triple burden of disease in LDCs will
cause millions to suffer
Action is required…we must begin…now…
THANK YOU