Transcript The first five leading causes of death in China (2007)

Implementation of
National/Regional programs
to prevent COPD
Nan Shan Zhong
Chinese Medical Association
The first five leading causes of death
in China (2007)
Urban
Rank
Disease
(ICD-10)
Rural
Mortality
(1/100,000)
%
Disease
(ICD-10)
Mortality
(1/100,000)
%
1
Malignant
tumor
176.2
28.5
Malignant tumor
114.2
24.8
2
Cerebrovascul
ar diseases
111.5
18.0
Cerebrovascular
diseases
119.7
20.6
3
Heart
diseases
100.6
16.3
Respiratory
diseases
100.2
16.2
4
Respiratory
diseases
80.9
13.1
Heart diseases
86.0
14.8
Trauma/
Poisoning
52.1
9.0
5
Trauma/
Poisoning
37.6
6.1
Prevalence of COPD in China:
Population (>40y ): 8.2% (M-12.4% ,F-5.1% )
Total: 32.8 millions
8.1%-24.1% (perennial:25.6% of total)
CRD in China
Current patient
COPD
32.8 millions
Asthma
15.0 millions
Allergic rhinitis 113 millions
COPD: one of the first leading
causes of death in China (2000)
Diabetes
1.2% (90,000)
Cardiovascular disease
15.0% (1.0M)
COPD
17.60% (1.28M)
Cerebrovascular disease
19.10% (1.4M)
Tumor
19.30% (1.4M)
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
MOH Disease Control Department and NCDC. Report on Chronic Disease in China. 2006.
Kong Lingzhi. 2005 Report in NCDC Annual Conference.
% Cause of death (2000)
GARD China Network
Dept of Chronic Disease
Control, Ministry of
Public Health, China
China GARD Alliance
Chinese
Association of
Respir.Dis
China Asthma Alliance
China COPD Alliance
CRD listed as priority in the 15year
plan of the control and prevention of
chronic non communicable diseases
(MOH 2007-2022)
Hypertension
Diabetes
Heart disease
Malignant tumor
Chronic respiratory disease
National/Regional programs to
manage COPD
↓Risk factors (Smoking cessation,
reduction of indoor/outdoor air pollution)
Intervention as early as possible
Development of effective and affordable
medication
WHO Framework Convention on
Tobacco Control (WHO/FCTC)
• Government ratified: Aug 28th, 2005
• Enforcement: Jan 9th, 2006
Tobacco Control Organizations in China

Ministry of Health

China CDC- National Tobacco Control Office

WHO Collaborating Center for Tobacco or Health

China Association On Tobacco Control

National Health Education Institute
Policy on Smoke Free Healthcare Facilities
Smoking forbidden in hospitals in China
50% hospitals at the end of 2010
100% hospitals at the end of 2011
MOH Document 21st May 2009
11th, March 2008
22th, May 2009
Regulations on No-Smoking in Public
Places in Beijing
Smoking is forbidden in the following public places:
1. Indoor areas of medical organizations;
2. Infant institutions and kingdergartens;
3. Middle schools, primary schools, mid-level vocational schools;
4. Universities and other teaching areas of educational and training
organizations.
5. Theatres, music halls, exhibition halls, museums, art galleries, libraries,
science and technology museums, archives, children’s palaces,
memorial halls and other places for science & teaching, culture and art.
6. Business center of commerce, finance, post and tele-communications;
7. Inside buses, taxis, rail transits and other public transportation tools,
related ticket offices and indoor platforms;
8. Cultural relics protection units open to the public;
9. Gymnasiums;
10. Contest area and seating area of stadium
These regulations are enacted from May 1st, 2008
Three National Prevalence
Surveys
Year
1984
1996
2002 2009
Total smoking rate
33.9%
37.6%
35.8%
Male
66.9%
66.0% 48%
Female
4.2%
3.08% 2.6%
(Aged>15)
Smoking rate in
male medical doctors
60.0%
56.8%
Haze in large cities
“Hazy sky” (NO VOC O3 etc) firstly listed
in the category of air pollution in the Pearl
River Delta Region
Document of Guangdong Government 1th May 2009
National/Regional programs to
manage CRD
↓Risk factors (Smoking cessation
reduction of indoor/outdoor air pollution)
Intervention as early as possible
Development of effective and affordable
medication
The trend towards development of
medicine
——Early prevention and intervention
A 3P modality
Predictive
Preventive
Personalized
Strategy of COPD management :
moving to the community level
Early
prevention
Early
management
Early
Early
prevention management
Medical costs
Clinical
management
Rescue
Medical costs
How to improve COPD management at
the community level
Increase government investment
Education among medical staff at the
community medical system
Research to early implement
intervention ;to develop “effective,
affordable, simple and safe” medications
China’s total health expenditure takes up only 17%
of government’s budget, compared with a mean of
40% in developing countries
80
70
Government budget
Social securities
60
Out of pocket
50
40
30
20
10
0
1980
1990
1995
2000
2002
2003
2004
2005
Data from MoH China (2006)
Increased government
investment
More investment in the
community health care system (in
the next 3 years)
Additional healthcare budget
850 billion Yuan
Wen Jiabao
National People’s Congress 2009
Routine (regular) lung
function test in the community
Health care system
How to improve community
health-care
Increase government investment
Education among medical staff at the
community medical system
Research to early implement
intervention ;to develop “effective,
affordable, simple and safe” medications
2007;175
prevalence of doctor-diagnosis
Diagnosed Rate of COPD Before
Epidemiologic Survey
40.0
35.0
30.0
25.0
chronic bronchitis
emphysema
bronchial asthma
COPD
one of above
20.0
15.0
10.0
5.0
0.0
total population
COPD population
Percentage of usage of
PFT
Usage of Lung Function Test
12.0
rural
urban
toatal
10.6
10.0
8.0
6.7
6.0
6.5
4.3
4.0
2.0
1.5
2.4
0.0
total population
COPD population
The Launch Meeting of China COPD Alliance in
Guangzhou, Nov 4, 2006
Program of COPD Prevention &
Management
Awareness: burden ,smoking hazards, air
pollution (including biomas fuels)
Smoking cessation campaign
Reduction of outdoor/indoor pollution
Public education (TV newspaper)
Research work:
a/ Early intervention-more treatable and reversible
b/ Develop effective and affordable medication
Training programme of the medical staff in
the community health care system (Early
2007)
Haerbin Mar 19
Shenyang Mar 26
Beijing Feb 25
Tianjin Feb 26
Jinan Apr 1
Nanjing Mar 25
Wuhan Mar 12
Shanghai Mar 4
Chongqing Mar 5
Hangzhou Mar 18
Guangzhou Mar 11
1st turn
2nd turn
Training programme of the medical staff in
the community health care system (late 2008)
Haerbin Sep 9
Shenyang Oct 14
Beijing Sep 10
Jinan Sep 24
Nanjing Sep 17
Wuhan Oct 21
Shanghai Sep 23
Chendu Sep 16
Hangzhou Oct 15
Guangzhou Oct 8
1st turn
2nd turn
The Launch Meeting of China Asthma Alliance
in Zhengzhou, June , 2005
Asthma Alliance
Implementation of 2008 GINA Guidelines
Training program of physicians in community
level
Knowledge of prevention and management of
asthma in the public and media
Development of a simplified guideline available
for the rural area (cost-effective)
Boycott fake medicine
Effective and affordable
Carbocisteine, theophylline in COPD
Half of GINA recommended dose in
asthma
Chinese traditional medicine
THANKS