Transcript Quotes from celebrities - World Health Organization

GARD
Global Alliance against Chronic
Respiratory Diseases
WHO
J Bousquet, R Dahl, N Khaltaev, HJ Bekedam
www.who.int/chp
GARD Launch Press
Conference
N Zhong (China):
Chronic respiratory diseases
(CRD) are a major burden in
China
S Hurd (USA):
The burden of CRD
N Khaltaev (WHO):
From the fragmented CRD
programs to GARD
J Bousquet (France): The GARD action plan
M Boland (Ireland):
Health promotion and CRD
prevention
J Walsh (USA):
The patient’s expectations
Suzanne S. Hurd USA
The burden of CRD
Chronic Respiratory Diseases: An
Increasing Global Public Health
Problem
•
The World Health Organization estimates that over 1 billion
people suffer from chronic respiratory diseases worldwide
•
Prevalence and severity are increasing globally
•
Cause substantial socioeconomic burden to individuals and
societies
•
In all countries, chronic respiratory diseases are:
– Under recognized
– Under diagnosed
– Under treated
Chronic Respiratory Diseases
(CRD)
• Asthma
• Allergic rhinitis
• Chronic obstructive
pulmonary disease
(COPD)
• Secondary pulmonary
hypertension
• Occupational chronic
respiratory diseases
• Chronic rhinosinusitis
• Post-infectious chronic
respiratory diseases
• Lung cancer; neoplasms
of the respiratory organs
• Pulmonary embolism
• Cor pulmonale
• Sleep apnea syndrome
• Lung fibrosis
Global Distribution – Chronic
Disease Mortality: All ages, 2005
> 4,000,000
7%
Communicable diseases;
Maternal/perinatal,
Nutritional deficiencies
Cardiovascular
Cancer
Chronic Respiratory
Diseases (CRD)
Diabetes
Other Chronic Diseases
Injuries
Source: Preventing Chronic Diseases, a vital investment, WHO, 2005
Increasing Burden of Diseases and Injuries:
Change in Rank Order of DALYs*
1999
1. Acute lower respiratory
infections
2. HIV/AIDS
3. Perinatal conditions
4. Diarrhoeal diseases
5. Unipolar major depression
6. Ischemic heart disease
7. Cerebrovascular disease
8. Malaria
9. Road traffic injuries
10. COPD
11. Congenital abnormalities
12. Tuberculosis
*DALY = Disability-adjusted life year
Source: WHO Evidence, Information and Policy, 2000
2020
1.
2.
3.
4.
5.
6.
Ischemic heart disease
Unipolar major depression
Road traffic injuries
Cerebrovascular disease
COPD
Acute lower respiratory
infections
7. Tuberculosis
8. War
9. Diarrhoeal diseases
10. HIV
…….
15. Trachea, bronchus, lung cancers
Chronic Respiratory Diseases
(CRD)
Global Prevalence
Asthma
> 300 million
Allergic rhinitis
> 400 million
Chronic obstructive > 80 million moderate
pulmonary disease to severe COPD; many
millions with mild COPD
Burden of Asthma
• Asthma is one of the most common
chronic diseases in the world
• Prevalence ranges from 1% to 18%
• An estimated 250,000 deaths annually,
many of them preventable
• Direct costs (hospital, medications)
account for 1-3% of total medical
expenses in most countries
Affordability of Asthma Drugs
Moderate persistent asthma, 1998
Drug cost (per year)
Nurse's salary (per year)
Algeria
Vietnam
Syria
Guinea
Mali
Ivory Coast
Burkina Faso
Turkey
0
100
200
Cost in US$
N. Ait-Khaled and al Int J Tuberc Lung Dis 2000; 4, 3: 268-271
300
400
Burden of COPD
• COPD is a major cause of morbidity, mortality
and disability
• High prevalence, morbidity and mortality of
COPD present challenges for healthcare
systems
• Despite its ease of diagnosis, COPD remains an
under-diagnosed disease, chiefly in its milder
and more treatable form
COPD Mortality by Gender, USA,
1980-2000
Number Deaths x 1000
70
60
50
40
Men
Women
30
20
10
0
1980
1985
Source: Mannino D, US CDC, August 2002
1990
1995
2000
Year
Environmental
tobacco smoke
Cigarette
Smoke
Fumes/gases
Indoor/outdoor
pollution
Occupational
dusts
Risk
Factors
for COPD
Nutrition
Socio-economic
status
Infections
Chronic Respiratory
Diseases
are a
Global Public Health
Problem
N Khaltaev - WHO
From the fragmented CRD programs
to GARD
WHA resolution 53.17
The 53rd World Health Assembly
• recognized the enormous human suffering caused by
chronic respiratory diseases (CRDs)
• and requested the WHO Director General to continue
giving priority to the prevention and control of CRDs
• with special emphasis on developing countries and
other deprived populations
WHA resolution 53.17, May 2000
endorsed by all 191 WHO Member States
WHO calls for a global and coordinated effort
to fight chronic respiratory diseases
GARD
GARD
• The Global Alliance against Chronic Respiratory
Diseases (GARD) is a voluntary alliance of
organizations, institutions, and agencies
working towards a common vision to improve
global lung health according to the local needs.
 Vision:
A world where all people can breathe freely:
Breath for all.
Fragmented success
stories
• Asthma and COPD plans:
- Brasil
- China
- Finland
- France
- Portugal
- USA
Experience from Brazil
• In Brazil since 2002 the ministry of health
provides free pharmaceutical assistance for
severe asthmatics.
• In the province of Salvador this lead to the
reduction of 55% of hospital submissions. The
mean annual income of families of severe
asthmatics increased by 10 %.
• The public health system has saved 566 US$
per patient per year.
A Success Story: France
• Increase awareness on
asthma (patients and public)
• Improve
– management of acute severe
asthma
– follow-up of asthmatics
– diagnosis and management of
childhood asthma in schools
• Increase patient education
• Better manage and prevent
occupational asthma
• Surveillance of asthma and risk
factors
Healthcare benefits from
asthma intervention
Asthma Indices
(base 100 in 1981)
350
Reimbursement asthma
Hospitalization days
Death rate
300
250
200
150
100
50
0
1981
1983
1985
1987
1989
Year
Haahtela et al, Thorax 1998
1991
1993
1995
J Bousquet - France
The GARD Action Plan
Specific Objectives of
GARD
 Build a stepwise and integrated program of
prevention and control of CRD.
 Improve collaboration between the fragmented
WHO and non-WHO programs.
 Increase awareness of CRD.
 Reduce the burden of CRD, and foster countryspecific initiatives appropriate to local needs.
 Focus on developing countries and deprived
populations.
Specific Objectives of
GARD
 Availability and affordability of medications
 Provide appropriate training for health care
personnel.
 Provide education to patients, care givers and
families.
Comprehensive
and integrated
action is the means
to prevent and
control chronic
diseases
Estimate population
needs and advocate
• WG.1- Burden, risk factors and surveillance
(G Viegi, S Buist, Y Fukuchi)
• WG.2- Awareness and advocacy
(C Lenfant, A Turnbull, P van Cauwenberge)
Formulate and adopt
policy
• WG.3- Prevention and health promotion
(M Boland, A Custovic)
• WG.4- Diagnosis of CRD and allergy
(K Rabe, S Wenzel)
• WG.5- Control of CRD and allergies, availability
and affordability of drugs
(J Bousquet, E Bateman, L Fabbri, C van Weel)
• WG.6- Pediatric asthma
(C Baena-Cagnani, E Mantzouranis, FER Simons,
E Valovirta)
Identify Policy
Implementation Steps
• The GARD action plan should be applied at the
country level.
• A national coordination group will:
– Provide existing national statistics on CRD
– Assess the specific needs for the given country
– Review the GARD action plan
– Determine the relevant issues for the country
action plan
– Develop a country-specific action plan
M Boland - Ireland
Health promotion and CRD prevention
Health promotion and
disease prevention
Key messages:
• Everyone has the right to live in a clean air
environment
• Environmental exposure to unhealthy
environment causes incurable COPD, asthma,
cardiovascular disease and cancer
• Complete elimination is the only way to remove
the risk
• This applies to tobacco smoke and all other at
risk environments
WG.3- Health promotion
and disease prevention
Goals:
• Help all countries to build and implement policies
to reduce the burden of
– tobacco smoke,
– indoor and outdoor pollution,
– occupational hazards
– and other risk factors of relevance for CRD
WG.3- Health promotion
and disease prevention
Some WHO programs are already available:
– FCTC (Framework Convention on Tobacco
Control)
– Healthy Environment for Children Alliance
– WHO program on prevention of allergy and
asthma
– Environment
– Occupational diseases
Tobacco Cessation
35
Smoking Ban
30
‘Slan’ Surveys
OTC/MRBI Tracker
25
20
% Smoking
15
10
No. of Smokers
fallen by 25%
5
0
1992
2000
2002
2004
2005
WG.3- Health promotion
and disease prevention
• Biomass fuels
– Over 2 billion people in the developing world
burn traditional biomass fuels indoor for
cooking and heating.
– Resulting in an estimated 1.6 million deaths
each year, largely among women and children.
– Acute respiratory infections and COPD
(700,000 deaths/yr)
J Walsh - USA
The patient’s expectations
Personal History of
J. Walsh
•
•
•
•
•
•
When did the disease start
Symptoms
Effects on daily life
Treatment
Expectations
Future
Patient’s Expectations from
GARD
•
Health care professionals should be able to
recognize CRD at an early phase and introduce
early management
•
The patient must be taken more seriously
about his/her symptoms
•
Health care systems should be structured to
manage patients with chronic disease,
including regular and long term follow up
….continued
Patient’s Expectations from
GARD (continued)
•
Health care systems should develop a
structured patient education, information and
training programs
•
General public should become more informed
of CRDs problems and take a more positive
attitude toward the needs of CRD patients
•
Societies should be more receptive to the
value of environmental changes
Doctors and Patients
must be
Partners in Care of
CRDs.
Conclusions
• Hundreds of millions of people suffer from
chronic respiratory diseases
• Over 4 million people die prematurely each year
• Huge economic burden
• In all countries, and particularly in developing
countries
• In all age groups
• Prevalence and mortality are increasing
www.who.int/chp