Chronic diseases worldwide

Chronic Diseases and Health Promotion – www.who.int/chp/enGlobal Alliance against Chronic Respiratory Diseases - www.who.int/respiratory/gard

Giovanni ViegiCNR Institute of Clinical Physiology, Pisa, Italy

2006-07 ERS Past Presidenton behalf of

Nikolai Khaltaev, MD, PhD Chronic Diseases and Health Promotion, WHO, Geneva (CH)

The World Health Organization (WHO): the Global Alliance against Chronic Respiratory Diseases (GARD) project in

Respiratory MedicineRoma, 15 novembre 2006

http://www.who.int/chp/en

http://www.who.int/respiratory/gard


Cardiovascular diseases mainly heart disease and stroke

Cancer Chronic respiratory diseases Diabetes

Chronic diseases worldwide




Chronic diseases in Spain

In Spain, chronic diseases are projected to account for 90% of all deaths




Chronic Respiratory Diseases

• including 300 million people with asthma,

Hundreds of millions of people have chronic respiratory diseases,

• 80 million people with moderate to severe chronic obstructive pulmonary disease (COPD)

• and millions of others with mild COPD, allergic rhinitis,

and other chronic respiratory diseases, which are often undiagnosed.




Some widespread misunderstandings about chronic respiratory diseases -

and the reality

87% OF CHRONIC RESPIRATORY DISEASES DEATHS OCCUR IN LOW & MIDDLE INCOME COUNTRIES

REALITY

MISUNDERSTANDINGCHRONIC RESPIRATORY DISEASES MAINLY AFFECT HIGH INCOME COUNTRIES

Upper middle income

countries 5%

Lower middle income countries

48%

Low income countries

34%

High income countries

13%

Projected global distribution of chronic respiratory disease deaths By World Bank income group, all ages, 2005




CHRONIC RESPIRATORY DISEASES AFFECT WOMEN AND MEN ALMOST EQUALLY

REALITY

Some widespread misunderstandings about chronic respiratory diseases -

and the reality

MISUNDERSTANDINGCHRONIC RESPIRATORY DISEASES MAINLY AFFECT MEN

Projected global distribution of chronic respiratory disease deaths all ages, 2005

men52%

women48%




The global epidemic of chronic respiratory diseases

4 000 000 PEOPLE

DIED FROM CHRONIC

RESPIRATORY DISEASES

IN 2005




Burden of Major Respiratory Conditions

Source: World Health Report 2003

DALYs* %

Bronchus /Trachea Cancer

Condition Deaths %

Lower Respiratory Infections 6.6 5.8COPD 4.8 1.9Tuberculosis 2.8 2.4Lung/ 2.2 0.8Asthma 0.4 1.0

Total 16.8 11.9

*DALYs = Disability-Adjusted Life-Years




What are DALYs?DisabilityAdjustedLifeYears

One DALY: one lost year of “healthy” life

DALY = YLD + YLL

55 65 75

COPDonset death expected

deathage (years)YLL

Years of Life LostYears of Life with Disability

YLD50




Increasing Burden of Diseases and Injuries:

Change in Rank Order of DALYs*Source: WHO Evidence, Information and Policy, 2005*DALYs = Disability-Adjusted Life-Years




Burden of COPD• COPD is a major cause of morbidity, death and

disability• The main cause for developing COPD is

tobacco smoking• COPD is not just simply a "smoker's cough",

but a disease that kills per year 3 million people worldwide

• Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form




<6.2 .6.2-9.7

9.7-15.7

18.1-19.919.9-22.1

35.5-38.122.1-35.5

15.7-18.1

>38.1no data

World map COPD - Deaths / 1000 year 2000




World map COPD – DALYs* / 1000 year 2000

<0.100.10-0.790.80-2.192.20-2.592.60-3.493.50-3.893.90-4.399

>6.704.40-6.69

no data *DALYs: disability-adjusted life year




The estimated DALYs* for COPD according to the population of each WHO region for the year 2005

Source: WHO, Evidence and Information Policy, 2005

*DALYs = Disability Affected Life Years




Prevalence of COPD in Europe




0 5000 10000 15000 20000

EUROPEDisease burden (DALYs) in 2000 attributable to selected risk

factors

Indoor smoke from solid fuels Unsafe water, sanitation, and hygiene

Underweight Childhood sexual abuse

Urban air pollution Occupational risk factors for injury

Iron deficiency Unsafe sex

Lead exposure Illicit drugs

Physical inactivity Fruit and vegetable intake

High Body Mass IndexCholesterol

Alcohol Tobacco

Blood pressure

Number of Disability-Adjusted Life Years (000s)

Tobacco

Urban airpollution




WHO global approach to control Chronic Respiratory

Diseases




As for 17 December 2004: 47 countries haveratified the treaty. On 27 February 2005:

the FCTC has entered into force and has become an International law.

Today the FCTC has 140 parties(16 November 2006)

Framework Convention on Tobacco Control (FCTC)




STEP

SuRF

FCTC

Prevention ofAllergy andAllergic AsthmaBased on the WHO/WAO Meeting on thePrevention of Allergy and Allergic AsthmaGeneva,8-9 January 2002

WHO/MNC/CRA/03.2



http://www.ginasthma.com/

http://www.goldcopd.com/pocketguide/toc.html


A new way to prevent and control chronic respiratory diseases

Global Alliance against Chronic Respiratory

Diseases



The enormous human suffering caused by chronic respiratory diseases (CRD) has been recognized by the

53rd World Health Assembly (May 2000) which requested the Director General to:

• To continue giving priority to prevention and control of noncommunicable diseases, including CRD, with special emphasis on developing countries and other deprived populations;

• To coordinate, in collaboration with the international community, global partnerships and alliances for resource mobilization, advocacy, capacity building and collaborative research


What is the value added of this new way?

The value added of developing an alliance with specialized national and international NGOs is to:

• To share responsibilities and building on each partner's expertise

• To combine the partners' strengths and knowledge, thereby achieving results that no one partner could attain alone.

• To improve coordination between existing governmental and nongovernmental programmes, which avoids duplication of efforts and wasting of resources.




Before GARD = lack of coordination, competition



http://images.google.it/imgres?imgurl=www.goldcopd.com/images/ginalogo.gif&imgrefurl=http://www.goldcopd.com/links.html&h=144&w=143&sz=10&tbnid=5cPNhpB4a38J:&tbnh=88&tbnw=88&start=7&prev=/images%3Fq%3DGINA%2Basthma%26hl%3Dit%26lr%3D%26ie%3DUTF-8

http://www.eaaci.org/bilder/glob5.gif


WHO calls for a global and coordinated effort

to fight Chronic Respiratory Diseases



http://images.google.it/imgres?imgurl=www.goldcopd.com/images/ginalogo.gif&imgrefurl=http://www.goldcopd.com/links.html&h=144&w=143&sz=10&tbnid=5cPNhpB4a38J:&tbnh=88&tbnw=88&start=7&prev=/images%3Fq%3DGINA%2Basthma%26hl%3Dit%26lr%3D%26ie%3DUTF-8

http://www.eaaci.org/bilder/glob5.gif


GARD Global Launch, 28 March 2006, Beijing, People's Republic of China

"GARD will provide an effective form in which health care workers, institutions and governments from all countries may jointly work to mobilize the entire population in efforts to prevent and control chronic respiratory diseases".

Dr Longde Wang Vice Minister of Health, People's Republic of China




GARD“I am happy to hear that the Global Alliance against Chronic Respiratory Diseases is now in place as a global team. As a team, each member will contribute his or her unique strengths, just like in football. Together, the Alliance's teamwork will provide help to the hundreds of millions of people who suffer from chronic respiratory diseases, including those in my country who do not have access to essential treatments.”

Pele, soccer legend




GARD"Reaching a major goal like conquering chronic respiratory diseases is similar to a marathon run: it's a big effort but with energy, knowledge, support and the will to win, it can be done. I am convinced that the Global Alliance for Respiratory Diseases will win the battle against chronic respiratory disease, which kills four million people a year"

Rosa Mota, former Portuguese marathon runner and Olympic champion




GARD contribution to prevent and control chronic diseases




GARD VisionA world where all people breathe freely




GoalTo improve global lung health

ObjectiveTo initiate a comprehensive approach to fight chronic

respiratory diseases through:

• developing a standard way of obtaining relevant data on chronic respiratory disease risk factors;

• encouraging countries to implement health promotion and chronic disease prevention policies; and

• making recommendations of simple strategies for management of chronic respiratory diseases.

GARD Goal and Objective




June 2004

WHOACAAIALATARIAATS EAACIEFAERSFILHAFIRSGA2LENGINAGOLD NHLBIWAOWHO-CC DU

Jan 2005

WHOAAAAIAAAFACAAIARIAATSEAACIEFAERSFILHAFIRSGA2LENGINAGOLDICCINTERASMAKAFNHLBIWAOWHO-CC DUWHO-CC UCMWONCA

February 2006

WHOAAA (D. Vervloet, France)AAAAI (E. Simon, CAN)AAAF (R. Pawankar, JAP)ACAAI (M. Blaiss, USA)AIMAR (C. Donner, ITA)ALAT (C. Luna, ARG)APAACI (T. Fukuda, JAP)APRS (Y. Fukuchi, JAP)ARIA (J. Bousquet, FRA)ATS (P. Wagner, USA)CCM (D. Greco, ITA)CNR-INMM (G. Rasi, ITA)DLHA (DK)EAACI (U. Wahn, GER)ECARF (T. Zuberbier, GER)EFA (S. Palkonen, FIN)ERS (R. Dahl, DK)FEMTEC (U. Solimene, ITA)FILHA (M. Nieminen, FIN)FIRS (A. Turnbull, SWI)GA2LEN (P. Van Cauwenberge, BEL)GINA (P. O’Byrne, CAN)GOLD (L. Fabbri, ITA)ICC (L. Grouse, USA)INTERASMA (I. Ansotegui, SPA)IPRAIS (J. Warner, UK)IPCRG (A. Ostrem, UK)IRCCS-SR (S. Bonini, ITA)

15

21

41GARD

Participants from

European Region

Oct 2002

WHOEFA

Jan 2003

WHOEFAARIA

IUATLD (N. Billo, FRA)KAF (Y. Kim, KOR)KTL (P. Puska, FIN)NHLBI (B. Alving, USA)RSP (A. Chuchalin, RUS)SFAIC (G.Pauli, FRA)SPAIC (M. Morais de Almeida)SPLF (B. Housset, FRA)TTS (A. Kocabas, TUR)WAO (C. Baena-Cagnani, ARG)WHO-CC DU (S. Makino, JAP)WHO-CC GU (G. Joos, BEL)WONCA (A. Loh, SIN)

2 3




GARD is part of WHO's work to prevent and control chronic

diseases

Comprehensive and integrated action is the means to prevent and control chronic diseases




GARD will contribute to the global goal

• A 2% annual reduction in chronic disease death rates worldwide, per year, over the next 10 years to 2015.

• The scientific knowledge to achieve this goal already exists.




9 out of 10 lives saved: low and middle income countries




Economic gain: billions




GARD Working Groups: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)




GARD Working Groups: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)




GARD governanceWHO: administrative secretariat

Leader: N.Khaltaev

Steering Committee: GARD administrative leader; GARD chair; GARD co-chair

Advisory Committee: in total 15 persons *GARD administrative leader; GARD chair; GARD co-chair *6 persons from scientific organisations, defined One person from each of the following member categories: *International governmental organizations *Nongovernmental organizations *National government - developed country *National government - developing country *Foundations*Academies and research institutes

Scientific Committee Work group chairs

Chairs of National GARD Committee

ExecutiveCommittee

(n=15)




Towards a Global Alliance against Chronic Respiratory Diseases at Country Level




Desired outcome at country level: initiated or upgraded CRD surveillance, prevention and control programme in the country

Approach: building an Alliance against Chronic

Respiratory Diseases at country level

HOW?

GARD - country




1. The basics of CRD surveillance, prevention and control programme are already in place in the country. If this is not true, the commitment to initiate a CRD programme shall be evident in the country.

2. The Ministry of Health of the country explicitly requests help to WHO and its partners for the development of an upgraded plan for surveillance, prevention and control of CRD

What are the necessary conditions that have to be in place in order to pursue the idea of developing a GARD-Country?




What is the value added?

Do the benefits outweigh the risks associated?

1. Is there the need for a Global Alliance against Chronic Respiratory Diseases at country level to upgrade the CRD surveillance, prevention and control programme?

This is a strategic allianceBetween organizations drawn from the different sector of societies (government, business, NGOs)Who commit to work collaboratively towards the common goal to improve lung healthIn which all partners contribute from their core expertiseShare risksAnd benefits by achieving their own, each others, and the overall goal of the alliance.

What are the steps to develop a GARD – Country?




Value AddedGARD – Country shall act as a

coordination and creation of a momentum that invites new inputs from various stakeholders,

in order to become a true national response to the need of initiating/upgrading the National CRD Programme.

It shall focus on what single partners cannot achieve alone:• Coordinating already existing activities related to CRD• Exchanging sound and relevant information• Raising greater awareness on CRD and their risk factors as well as on how to prevent and treat them• Generating political commitment at country level• Raising additional resources




2. GARD Country Coordinator

3. Making an inventory of stakeholders

4. Approaching other partners

5. Exploratory workshop

6. Terms of Reference

7. Structure

8. Don't forget to review your work from time to time

What are the steps to develop a GARD – Country? (cont.)




Ministry of HealthGARD Focal Point

GARD - CountryGARD - Country Coordinator

Universities

Hospitals

Professional Societies

Patients' Associations

National NGOs involved in community-

based interventions

Bilateral cooperative

agencies

Multilateral cooperative

agenciesPrivate sector representative

s

International NGOs involved in

community-based

interventions

WHO

General MeetingPlanning Group Secretariat




www.who.int/respiratory/gard





PARLEMENT EUROPÉEN

2004

2009

Commission de l'industrie, de la recherche et de l'énergie

27.10.2006 PE 380.783v01-00

AMENDMENTS 99-138

Projet de recommandation pour la deuxième lecture (PE 378.823v01-00) Jerzy Buzek Council common position for adopting a Decision of the European Parliament and of the Council concerning the Seventh Framework Programme of the European Community for research, technological development and demonstration activities (2007 - 2013)

Council Common Position (12032/2/2006 – C6-0318/2006 – 2005/0043(COD))

Amendment by Jerzy Buzek on behalf of the PPE-ED Group, Philippe Busquin on behalf of the PSE Group, Vittorio Prodi on behalf of the ALDE Group and Umberto Guidoni on behalf

of the GUE/NGL Group

Amendment 114 Annex I, Chapter I "Cooperation", Theme 1 "Health", Subtitle "Activities", bullet 2, indents 3

and 4

- Translational research in infectious diseases: to address drug resistance, the global threats of HIV/AIDS, malaria and tuberculosis, as well as Hepatitis C and potentially new and re-emerging epidemics (e.g. SARS and highly pathogenic influenza).

- Translational research in major diseases – cancer, cardiovascular disease, diabetes/obesity; rare diseases; other chronic diseases including rheumatoid diseases, arthritis and musco-skeletal diseases: to develop patient-oriented strategies from prevention to diagnosis with particular emphasis on treatment, including clinical research. Aspects of palliative medicine will be taken into account.

- Translational research in infectious diseases: to address drug resistance, the global threats of HIV/AIDS, malaria and tuberculosis, as well as Hepatitis and potentially new and re-emerging epidemics (e.g. SARS and highly pathogenic influenza).

- Translational research in major diseases – cancer, cardiovascular disease, diabetes/obesity; rare diseases; other chronic diseases including arthritis, rheumatic and musculo-skeletal diseases and respiratory diseases including those induced by allergies: to develop patient-oriented strategies from prevention to diagnosis with particular emphasis on treatment, including clinical research and the use of active ingredients. Aspects of palliative medicine will be taken into account.

Or. en

Justification

Amendment tabled with a view to reaching an agreement with Council

Chronic diseases worldwide

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