Transcript TAIEX_Dimitrov_presentation_2

Monitoring and prevention of NCDs and
Health Inequalities related to NCDs in
Bulgaria
Prof. Plamen Dimitrov
National Centre of Public Health and Analyses, Bulgaria
NFP for NCD for both WHO Europe and SEEHN
Prof. Vesselka Duleva
National Centre of Public Health and Analyses, Bulgaria
NFP for nutrition for WHO Europe
Mortality by causes
Source: National Center of Public Health and Analyses, Bulgaria
SDR from major NCDs
SDR, diseases of circulatory
system, all ages, per 100 000
SDR all causes, all ages, per 100 000
1300
900
1200
800
1100
700
1000
600
Bulgaria
EU
900
Bulgaria
EU
500
800
400
700
300
600
500
1970
1980
1990
2000
2010
200
1970
2020
1980
1990
2000
2010
2020
SDR, diseases of respiratory
system, all ages, per 100 000
SDR, malignant neoplasms, all ages, per 100 000
210
200
200
190
150
180
Bulgaria
EU
170
Bulgaria
EU
100
160
150
50
140
130
1970
1980
1990
2000
2010
2020
Source: HFA-DB, WHO/EURO, 2014
0
1970
1980
1990
2000
2010
2020
Burden of NCD in Bulgaria
Total NCD
deaths
(‘000s)
NCD deaths Age-standardized death rate Age-standardized death rate
under age 70
per 100,000 (males)
per 100,000 (females)
(percent of all
NCD deaths)
m
f
m
f
53.2
50.6
40.0
21.0
All
NCDs
CA
849.2 179.1
COPD
CVD
All
and NCDs
diabet
es
26.3
566.6 513.9 100.6
Source: Global status report on noncommunicable diseases 2010. WHO
CA
COPD
CVD
and
diabet
es
10.8
367.7
Burden of NCD in Bulgaria
Age-standardized mortality rates by cause
(per 100 000 population)
• Communicable diseases - 31
• Noncommunicable diseases - 693
• Injuries - 42
Distribution of years of life lost by broader causes (%)
• Communicable diseases - 5
• Noncommunicable diseases - 86
• Injuries - 9
Source: World Health Statistics 2010
Prevalence of selected risk factor in Bulgaria
Men
Women
Total
Rank in
WHO/EURO
Smoking
41.9
27.2
34.3
M-10
F-4
Low
physical
activity
24.6
31.8
28.4
M-27
F-23
Obesity
23.1
24.3
23.7
High blood
pressure
52.6
50.3
51.4
Source: Global status report on noncommunicable diseases 2010. WHO
M-7
F-7
Programs on Prevention of NCD in Bulgaria
• CINDI - Countrywide Integrated Noncommunicable Disease
Intervention Program – 1994-2010. There are currently
ongoing programs on municipality level.
• National program on smoking prevention – 2002-2005 and
2007-2010
• National Action Plan “Foods and Nutrition” – 2005-2010
• National Program on Prevention and Control of Noncommunicable diseases – 2014-2020
National Program on prevention and control of NCD in
Bulgaria - 2014-2020
Strategic goal
• To promote population’s health and improve quality of life by
reducing premature mortality, morbidity and health outcomes
(disability) of major NCDs (cardiovascular diseases, malignant
neoplasms, chronic lung diseases, diabetes) associated with risk
factors - tobacco use, alcohol abuse, unhealthy diet and low
physical activity.
Main goal
• To implement a systematic national policy for:
• reducing the level of the most common risk factors for NCDs:
behavioral, biological, psychosocial by decreasing the prevalence of
smoking, alcohol abuse, improving the nutrition and increasing the
physical activity;
• early diagnosis of the main NCDs.
National Program on prevention and control of NCD
in Bulgaria - 2014-2020 - targets
• Cardiovascular diseases:
• Reducing the mortality from coronary heart disease by 10%.
• Reduction in mortality from cerebrovascular disease by 10%.
• Reducing the prevalence of arterial hypertension in the age group 25-64 by
10%.
• Malignant neoplasms:
• Reducing the mortality from malignant neoplasms;
• Increasing by 30% of the number of cases with malignant neoplasms found
through medical check-ups or screening tests in localizations subject to
screening (breast cancer, colon and rectum cancer);
• Decreasing by 30% of the cases with advanced malignant neoplasm in
localizations subject to screening test (breast cancer, colon and rectum
cancer);
• Retaining the mortality from malignant neoplasns.
National Program on prevention and control of NCD
in Bulgaria - 2014-2020 - targets
• Chronic respiratory diseases:
• Reducing the mortality from COPD by 5%;
• Reducing the number of the percentage of COPD patients, who have
some restrictions in the daily activities due to the illness.
• Diabetes
• 10% relative reduction in prevalence of diabetes (defined as
increased blood glucose ≥ 7.0 mmol/L or persons treated for
diabetes) among those aged over 25 years;
• Retaining the disability due to diabetes
National Program on prevention and control of NCD in
Bulgaria 2014-2020 - targets
• Use of tobacco products
Reducing smoking prevalence among the population by 10%
Reducing the level of distribution of cigarette smoking initiation in children aged 13 by 50%;
Reducing the intensity of smoking in smokers - men and women aged 25-64 by 50%;
Increasing the number of patients - regular smokers who received advice from their doctor
to quit using tobacco products up to 50%;
• Reducing the number of pregnant women who smoke during pregnancy by 50%;
•
•
•
•
• Alcohol abuse
Reducing average alcohol consumption per capita by 5%;
Reducing the proportion of persons abusing with alcohol by 30%;
Reducing alcohol consumption in children under 18 years of age by 50%;
Restriction of the risk and high-risk alcohol consumption among persons 18 to 25 years of
age by 20%;
• Increasing the number of trained specialists to implement preventive and treatment
activities in terms of avoiding and limiting the alcohol abuse by 10%
• Increasing the number of alcohol abusing patients up to 50% who received a consultation
from their GP to quit alcohol use.
•
•
•
•
National Program on prevention and control of NCD in
Bulgaria 2014-2020 - targets
• Physical activity
• Increasing the relative proportion of persons practicing physical activity of
moderate intensity at least 30 minutes 5 days a week by 25%.
• Increasing the proportion of children who practice daily physical activity with
moderate to high intensity for at least 60 minutes a day by 30%.
• Reducing the proportion of persons aged over 18 years who practice physical
exercise, sports and tourism once a week and rarely by 10%.
• Nutrition
• Stopping the trend of increasing the prevalence of obesity in adult
populations;
• Maintaining but without increasing in the proportion of overweight children
(overweight and obesity);
• Reducing the use of industrially produced trans-fatty acids (hydrogenised
plant oils) in food provision;
• Reducing salt consumption for achieving of a long-term goal up to 5 g per day
per person;
Monitoring in Bulgaria - examples
CINDI Health Monitor
• The CINDI Health Monitor is a survey to reflect health
behaviour and lifestyle related risk factors to carry out at the
CINDI demonstration area, at regional or national level. CINDI
Health Monitor survey was introduced in CINDI participating
countries in 2000
• The survey is based on the questionnaire and experience of
the FINBALT Health Monitor project.
• Questionnaire included personal data, health data, smoking
history, eating habits, alcohol use, physical activity, healthy
lifestyle and behaviour knowledge.
• CINDI Health Monitor in Bulgaria – 2002 and 2007
• Survey in 2007 involved 10 500 men and women.
National behavioral risk factor survey among
population 25-64 - 2007
National behavioral risk factor survey among
population 25-64 - 2007
• Standardized one-on-one interview according to a Survey Card
– a Questionnaire administered within the CINDI Programme
with survey-relevant addenda – was used for source data
collection.
• The Survey Questionnaire (SQ) is designed in sections. The SQ
sections included: personal data, health data, smoking history,
eating habits, alcohol use, physical activity, healthy lifestyle and
behaviour knowledge.
• The survey sample was drawn by the National Institute of
Statistics.
• The sample was two-staged cluster sample representative of
the cities and villages at national level.
National behavioral risk factor survey among
population 25-64 - 2007
• Proportion of Smokers among the Interviewees by Gender and
Age Groups (%)
National behavioral risk factor survey among
population 25-64 - 2007
• Alcohol Consumption among the Interviewees by Gender and Age
Groups (%)
National behavioral risk factor survey among
population 25-64 - 2007
• Intensive and moderate physical activity
70
Мъже
men
60
women
Жени
50
60
men
Мъже
women
Жени
50
40
40
30
30
20
20
10
10
0
0 0days
6 days
дни 1 days
1 ден 2-3
2-3days
дни 4-5
4-5days
дни above
над 6 дни
Intensive Physical activity: every day have only
5.9% of males and 2.8% of females.
0
00 дни
days
1 ден
days
above
6 days
2-3
days 4-5
2-3 дни
4-5 дни
6 дни
days над
Moderate Physical Activity: every day have only 8% of
males and 6.4% of females.
National Risk factors survey 2014
• The survey is within the National Program on prevention of
NCD in Bulgaria 2014 – 2020
• In all 28 districts in Bulgaria.
• Sample size 4000 participants.
• The methodology is the same as national survey in 2007
• Thus the comparison of results will be possible.
• In 2020 is envisaged survey (at the end of the program)
which will allow evaluation of the Program implementation
National Monitoring System of Nutrition
Since 1997 - 12 studies on assessment of dietary intake and
nutritional status have been conducted by the (NCPHA)
• National survey on dietary intake and nutritional status of Bulgarian
population (over 1 year of age) - 1997, 1998, 2004 (the next one –
2014 under NPPCD)
• National survey on dietary intake and nutritional status of women in
fertile age in Bulgaria (16 - 45 years) - 1998
• National survey on nutrition and nutritional status of schoolchildren in
Bulgaria (7-19 years) – 1998, 2011
• WHO Childhood Obesity Surveillance Initiative (7-8 years) – 2008,
2013
• National survey on nutrition of infants and children under 5 and family
childrearing practices in Bulgaria - 2007
• National survey of institutionalised children, aged 0-3 years – 2000
• National nutrition survey of institutionalised children of age 7-16
years – 1997
Main characteristics of the Diet
• Low intake of vegetable and fruits in winter/spring seasons great season differences in raw vegetable and fruit intake
• Low intake of dietary fiber due to the greater consumption of
refined products and low intake of whole-grain cereals and
pulses
• High salt intake (1-3 times over the recommended values) - high
consumption of salty foods - preserved meat and pickled
vegetables
• Traditionally low fish consumption: 4-10 g daily as an average
• Insufficient intake of milk and dairy products
• High level of alcohol consumption, especially for males 30-60
years of age (about 30 -50 g ethanol/day)
• Insufficient variety of consumed food products
Overweight and obesity prevalence in schoolchildren (National
survey on nutrition and nutritional status of schoolchildren in
Bulgaria -1998, 2010-2011)
1998
2010/2011
The Prevalence of overweight and obesity of school children aged 7 years –
WHO Childhood Obesity Surveillance Initiative in Bulgaria, 2008 and 2013
Prevalence of Overweight and Obesity of adults (19 – 60 years old)
National Monitoring of Dietary Intake and Nutritional Status, 1998, 2004
Prevention activities - example
• Food and nutrition action
plan, 2005-2010
• Formulated the main
priorities and activities in
Bulgarian Nutrition Policy
• Goal:
• To achieve positive changes in
the national dietary pattern
for decreasing the risk of
nutrient deficiencies and dietrelated chronic diseases
• Bulgarian Food-Based Dietary
Guidelines
Bulgarian Food-Based Dietary Guidelines
• Formulated scientific evidenced based Bulgarian Food-Based
Dietary Guidelines for different population groups aiming to
achieve positive changes in national dietary pattern
• The national FBDG contain 12 specific for every population
group recommendations. They include a specific guidelines for
reduction intake of high fat/saturated fat, high sugar, high salt
contented products.
• Healthy Eating Pyramid has been developed.
• National recommendations for breastfeeding and
complementary feeding of infants, for healthy diet of women in
childbearing age, during pregnancy and lactation were
established.
Bulgarian Food Based
Dietary Guidelines for
different population
groups
National Documents and Regulations developed for
supporting healthy nutrition of Bulgarian Population
• Ordinance for healthy nutrition
- of schoolchildren, 2009
- of children 3-7 years old in kindergarten, 2011
- of children 0-3 years old in crashes, 2013
• Manuals for healthy nutrition with recipes with reduced
Energy/Fats/Saturated Fats/Sugars/Salt:
-
catering and canteen facilities, 2000
school children catering and canteen facilities, 2002, 2012
children 3 – 7 years old catering and canteen facilities with manual, 2004
Children 0-3 years old in crashes, 2013
• Weekly menu for national program “School milk” according to healthy
nutrition, 2008
• National Strategy “Fruit scheme”, 2010
• Dietary Reference Values for Energy and Nutrients for Bulgarian
population, 2005
Manuals for healthy nutrition with recipes
• Mandatory use on national level
Project BG051PO001-5.3.01 „Informed and Healthy “ within EU Operational
Program “Human Resources Development ”2007-2013", co-financed by EU
European Social Fund
National public awareness campaigns
“Stop and Examine Yourself”
Overview
• Duration - 65 months (21/05/2009 – 21/10/2014)
• Objective - raising awareness and informing the public about the nature and
benefits of cancer screening (400 000 cancer screening tests, public
awareness campaigns, creation and implementation of a national screening
registry)
• Target groups:
• Cervical cancer screening - between 25 – 60 (250 000)
• Breast cancer screening - between 50 – 69 (50 000)
• Colorectal cancer screening - both gender - 50 and above (100 000)
• Method – sending invitations to people at risk + public awareness
campaigns
• 120 hospitals included (continuous registration)
Evaluation
• Good practice screening Tool Kit (booklet)
• 40 000 screening tests (Feb 2014)
• Creation and implementation of National Screening
registry (includes GP registrations, printing and sending
invitations to target groups, screening examinations registrations)
EHIS – European Health Interview Survey
• The survey is a part of the European Health Survey System in
the framework of the European Statistical System. The EHIS
aims at measuring on a harmonised basis and with a high
degree of comparability among EU Member States, the health
status, life style (health determinants) and health care services
use of the EU citizens.
• Bulgaria participated in 2009
• In Bulgaria the survey was carried out by NSI based on
harmonized instruments in 2008.
• Currently second EHIS is underway
Health Inequalities – some examples and
activities
Health and the Roma community, analysis of the situation in Europe.
Preliminary National Report – Bulgaria
Project received funding from the EU in the framework of the Public Health Programme
Health and the Roma community, analysis of the situation in Europe Preliminary
National Report – Bulgaria
In Bulgaria the Project was implemented by Foundation "The health of Romany people"
• Very serious problems in Roma neighborhoods are linked with
infectious diseases.
• The elderly and children were the most vulnerable age groups: 39.6% of
Roma over 45 and 38.2% of children aged 0-9 had been sick.
• Children most frequently suffered from the common cold, flu and cough.
• Adults suffered more symptoms indicative of different diseases: heart
disease, bone and joint disease, kidney problems, nervous system
disorders or viral diseases.
• This survey showed that 12% of the entire Roma population (including
children) suffers from some type of disability or from a serious chronic
disease.
• One third of men and two fifths of women age 45–60 have partially or
entirely lost their ability to work due to poor health.
• The proportion of those suffering from chronic disease or disability in
the over 65 group rises to 70%. Three fifths of the men and three
quarters of the women claimed they have some chronic disease or are
disabled.
Health and the Roma community, analysis of the situation in Europe.
Preliminary National Report – Bulgaria
Risk factors prevalence
• Over half of the Roma men and one third of the women smoke on a
daily basis. The highest proportion of heavy smokers is in the 30-44
year old group where 52% smoke on a daily basis.
• In 17.4% of households at least one member has a problem with
alcohol or drugs. These problems are more frequent in households
located in poor, run-down buildings (21%) and in isolated
neighborhoods (22%).
• 90% of the Roma population over 30 do not practice sport or do any
physical exercise.
• The daily diet of Roma is unbalanced towards bread, starchy foods and
sweets. A quarter of the population eats fruit only once or twice a
week and one third consumes fruit occasionally or never. Fish is
extremely rate in their diet and they do not eat a sufficient quantity of
vegetables.
Health and the Roma community, analysis of the situation in Europe
Preliminary National Report – Bulgaria
Distribution of the population with disability or chronic diseases by sex and age groups (in%)
Males
Females
Both
Total
Number
Percentage of people who have a long-term or chronic illness (%)
age
Bulgarians
Turks
Roma
Percentage of people who have limitations in carrying out routine activities because of health problems or disability (%)
age
Bulgarians
Turks
Roma
Policy documents in Roma health
• National Roma Integration Strategy of the Republic of Bulgaria
(2012-2020) (adopted by the Parliament on 1 May 2012
• Action plan for implementation of the National Roma Integration
Strategy of the Republic of Bulgaria (2012- 2020) and the decade
of Roma inclusion 2005-2015
• Health strategy for disadvantaged persons belonging to ethnic
minorities (adopted by the Government on 27 July 2011)
Reducing health inequalities: preparation for action
plans and structural funds projects
• General objective of the project was to improve health and quality
of life of citizens by addressing health inequalities (HI) by means of
health promotion (HP) and by increasing the capacity of
stakeholders within European regions to use health promoting
interventions to effectively address HI as a core part of regional
action plans.
• Project connected 10 countries from different parts of EU in a
meaningful partnership, using their existing capacity in reaching
synergistic and sustainable effects.
• The project increased the capacity at regional level, which has
already been identified as an obstacle in the use of structural funds
(SF)
Reducing health inequalities: preparation for action
plans and structural funds projects
•
•
•
•
•
•
The general objective has been achieved through the
implementation of 6 specific objectives:
To carry out the situation overview and needs assessment with regard
to basic socioeconomic determinants of health and structural funds
plan at country level and in one chosen region.
To identify examples of good practice for tackling HI in partner and
other EU countries.
To increase the capacity of public health professionals (PHP) to reduce
HI.
To prepare the action plans for tackling HI by means of health
promotion at regional level, compatible with structural funds criteria.
To implement one objective from the action plan in each
region/country.
To increase public health capacity to address HI by using structural
funds.
Thank you for your attention