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KAUNAS UNIVERSITY OF MEDICINE
FACULTY OF PUBLIC HEALTH
DEPARTMENT OF PREVENTIVE MEDICINE
“INTERNATIONAL HEALTH:
NONCOMUNICABLE DISEASES
AS GLOBAL HEALTH PROBLEM”
PROF. Vilius GRABAUSKAS
FROM BISPH TRAINING COURSE
PUBLIC HEALTH SCIENCE
LEARNING OBJECTIVES
 TO
UNDERSTAND THE TRANSITION IN
GLOBAL HEALTH
 TO UNDERSTAND THE CAUSES OF THE
ABOVE
TRANSITION
 TO UNDERSTAND WHO’s POLICY AND
STRATEGIES TO COMBAT THE EPIDEMICS
OF NONCOMMUNICABLE DISEASES
Vilius GRABAUSKAS
THE WORLD HEALTH IS IN TRANSITION
EPIDEMIOLOGICAL :
NCDS OVERRIDING
INFECTIOUS DISEASES AND DOUBLE
BURDEN OF DISEASES IN MANY
DEVELOPING COUNTRIES
LIFESTYLES:
TOBACCO USE IS INCREASING
DIETS ARE RAPIDLY CHANGING
PHYSICAL ACTIVITY REDUCES
ALCOHOL USE INCREASES, OBESITY,
DIABETES, HYPERTENSION ARE
INCREASING IN MOST PARTS OF THE
WORLD, WHILE UNDER-NUTRITION
REMAINS A SEVERE ISSUE
DEMOGRAPHIC
:
POPULATION AGEING.
GLOBALIZATION : INCREASING GLOBAL INFLUENCES
Vilius GRABAUSKAS
THE GLOBAL NCD REALITY
 NONCOMMUNICABLE DISEASE CONTRIBUTE 60 % OF
DEATHS AND 43 % OF THE GLOBAL BURDEN OF DISEASE.
ALREADY 79% OF THESE NCDS ARE OCCURRING IN
DEVELOPING COUNTRIES.
 BY 2020 THESE DEATHS WILL ACCOUNT FOR 73%
DEATHS AND 60% OF THE DISEASE BURDEN.
 HALF OF THESE DEATHS ARE ATTRIBUTABLE TO
CARDIOVASCULAR DISEASES.
 THERE ARE MORE CVD DEATHS IN INDIA OR CHINA
THAN IN ALL DEVELOPED COUNTRIES ADDED
TOGETHER.
Vilius GRABAUSKAS
WORLD, DEATHS, BY BROAD CAUSE
GROUP, 2001
Total deaths: 56,554,000
58,5%
Communicable
diseases,
maternal and
perinatal
conditions and
nutritional
deficiencies
(18.4 million)
32,5%
Noncommunicable
conditions
(33.1 million)
9,0%
Injuries
(5.1 million)
Source: WHR 2002
Vilius GRABAUSKAS
WORLD, DALY’s, BY BROAD CAUSE GROUP,
2001
45,9%
Communicable
diseases, maternal
and perinatal
conditions and
nutritional
deficiencies
42,0%
Noncommunicable
conditions
12,2%
Injuries
Source: WHR 2002
Vilius GRABAUSKAS
DEATHS, BY BROAD CAUSE GROUP AND
WHO REGION, 2001
Noncommunicable
conditions
Injuries
75%
Communicable diseases,
maternal and perinatal
conditions and
nutritional deficiencies
50%
25%
AFR AMR EMR EUR SEAR WPR
Source: WHR 2002
Vilius GRABAUSKAS
DALY’s, BY BROAD CAUSE GROUP AND WHO
REGION, 2001
Noncommunicable
conditions
Injuries
75%
Communicable diseases,
maternal and perinatal
conditions and
nutritional deficiencies
50%
25%
AFR AMR EMR EUR
Source: WHR 2002
SEAR WPR
Vilius GRABAUSKAS
WORLD, DISTRIBUTION OF CAUSES OF
DEATH, 2001
Total deaths: 56,554,000
Other NCDs
Respiratory infections
Respiratory diseases
Neuropsychiatric disorders
3%
HIV/AIDS
6%
7%
Digestive diseases
4%
Perinatal conditions 5%
5%
Malignant neoplasms
Diarrhoeal diseases 3%
13%
Tuberculosis 3%
Childhood diseases
Diabetes
Malaria
Maternal conditions
9%
Nutritional deficiencies
30%
Other CD causes
Injuries
Cardiovascular diseases
Source: WHR 2002
Vilius GRABAUSKAS
WORLD
DISEASE BURDEN (DALY’s), 2001
Maternal conditions
Respiratory infections
Malaria
6%
Childhood diseases 3%
Diarrhoeal diseases 4%3%
Perinatal conditions
Nutritional deficiencies
Other NCDs
7%
Malignant neoplasms
5%
Diabetes
Neuropsychiatric
13%
disorders
HIV/AIDS 6%
Tuberculosis
Other CD causes 6%
3%
12%
Injuries
Congenital abnormalities
Musculoskeletal diseases
Source: WHR 2002
10%
3% 4%
Sense organ disorders
Cardiovascular diseases
Respiratory diseases
Digestive diseases
Diseases of the genitourinary
system
Vilius GRABAUSKAS
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Part of this lecture
NCD’s ARE TO A GREAT EXTEND
PREVENTABLE
 KEY RISK FACTORS: UNHEALTHY DIET (SALTY, FATTY
AND SUGARY FOOD), PHYSICAL INACTIVITY, TOBACCO
AND ALCOHOL DRINKING.
 THE BEHAVIOURAL FACTORS LEAD TO HIGH BLOOD
PRESSURE & HYPERTENSION, BLOOD GLUCOSE
INTOLERANCE & DIABETES, ELEVATED BLOOD
CHOLESTEROL & HYPERCHOLESTEROL, ANAEMIA,
OVERWEIGHT AND OBESITY.
 SIMPLE CHANGES IN THESE LIFESTYLES CAN
POWERFULLY PREVENT CHRONIC DISEASES AND
PROMOTE HEALTH.
 SOME OF THE CHANGES TAKE PLACE RELATIVELY
QUICKLY AND ALSO IN LATE AGE.
Vilius GRABAUSKAS
WHAT PREVENTS EFFECTIVE NCD ACTION?
MYTHS ABOUT NCDs: diseases of affluence, of
ageing, of men
UNDERESTIMATION OF PREVENTION IMPACT
MYTH OF CONG DELAY IN PRENTION EFFECT
LOW PUBLIC VISIBILITY (Perceived threat)
LACK OF DIRECT ECONOMIC INTERESTS (vs
drugs or clinical measures)
CONFLICTING MESSAGES, often related to
commercial interests
INERTIA IN CHANCE: administration, financing,
services etc
Vilius GRABAUSKAS
WHO RESPONSE
 EVIDENCE BASE, ADVOCACY, SURVEILLANCE, TRAINING
 NATIONAL PROGRAMMES AND POLICIES
 REGIONAL ACTIVITIES : WHO REGIONAL OFFICES AND
REGIONAL NETWORKS
 GLOBAL ACTION: PARTNERSHIP, ATTENTION TO GLOBAL
ASPECTS (MARKETING, TRADE, COMMUNICATION ETC)
 SURVEILLANCE AND MONITORING
Vilius GRABAUSKAS
WHO RESPONSE
WHO’S GLOBAL STRATEGY FOR NCD PREVENTION
AND CONTROL (WORLD HEALTH ASSEMBLY 2000)
 NCDS A PRIORITY
 PREVENTION KEY
 INTEGRATED PREVENTION
 TARGETS MAIN COMMON RISK FACTORS
- TOBACCO
- UNHEALTHY DIET
- PHYSICAL INACTIVITY
Vilius GRABAUSKAS
HEALTHY LIFESTYLES
 FOR INDIVIDUAL:
EFFECTIVE WAY TO
PREVENT DISEASES AND PROMOTE HEALTH
 FOR THE SOCIETY:
A COST EFFECTIVE AND SUSTAINABLE WAY
TO IMPROVE PUBLIC HEALTH
Vilius GRABAUSKAS
STRATEGIES TO REDUCE RISK:
WORLD HEALTH REPORT 2002 MESSAGES
 VERY SUBSTANTIAL HEALTH GAINS CAN BE MADE FOR RELATIVELY
MODEST EXPENDITURES ON INTERVENTIONS
 CHANGING POPULATION DISTRIBUTIONS OF RISK FACTORS (LIKE
BLOOD PRESSURE, BLOOD CHOLESTEROL) THROUGH GENERAL
LIFESTYLE CHANGES
 CVD: POPULATION WIDE STRATEGIES TO LOWER CHOLESTEROL
(QUALITY OF FAT) AND BLOOD PRESSURE (SALT REDUCTION) KEY
 TOBACCO: HIGHER TAXES, COMPREHENSIVE ADVERTISEMENT BAN
 MIX OF POPULATION WIDE, HIGH RISK AND SECONDARY PREVENTION
MEASURES, IN A COST EFFECTIVE BALANCE
 SUSTAINED POLICY ACTION
 STRENGTHENING OF NATIONAL INSTITUTIONS TO IMPLEMENT AND
EVALUATE RISK REDUCTION PROGRAMMES
Vilius GRABAUSKAS
NCD PREVENTION AND HEALTH
PROMOTION NETWORKS
GLOBAL INTEGRATED NCD PREVENTION NETWORKS
CINDI
CARMEN
EMAN
EUROPEAN NETWORK IN 27 COUNTRIES
LATIN AMERICAN NETWORK IN 8
COUNTRIES INITIATIVE IN EASTERN
MEDITERRANEAN REGION
NANDI
(SEARO)
INITIATIVE IN THE AFRICAN REGION
SOUTH EAST REGION: PLANS ARE
UNDER WAY
(WPRO)
WESTERN PACIFIC REGION : PLANS ARE
UNDER WAY
MEGA COUNTRY HEALTH PROMOTION NETWORK: 11 COUNTRIES; OVER
100 MIL. PEOPLE
Vilius GRABAUSKAS