NON-COMMUNICABLEDISEASES

Takeda Medical Publication ClubEric Feng, Medical Science LiaisonSincerely Presents

WHO: Global Status Report on Non-communicable Diseases

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Non-communicable Diseases (NCDs)

DiabetesCardiovas

cular

Chronic Lung

Malnutrition Lower back

Pain

Down Syndrome

Cancer Cystic

Fibrosis

Chronic kidney

PHYSICAL INACTIVITY

TOBACCO USE UNHEALTHY DIETS

HARMFUL USE OF ALCOHOL

GENETIC DISORDERS

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While global health resources are currently focused largely on infectious diseases, NCDs affect more people and are a “silent epidemic” in middle-income countries.

NCDs ARE THE LEADINGCAUSE OF DEATH GLOBALLY

NON-COMMUNICABLE DISEASES•Cardiovascular •Cancer •Chronic

Lung •Diabetes

63%

OF AllGLOBALDEATHS

ARE CAUSEDBY

80% OF DEATH OCCUR IN LOW AND MIDDLE-INCOME COUNTRIES

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GLOBAL NCDs FACTs

WHO INDICATES THAT NCDs DEATHs ARE PROJECTED TO INCREASE BY 15% GLOBALLY BETWEEN 2010 AND 2020 (TO 44 MILLION

DEATHs )

TOTAL DEATHS

70%People

≥ 60 years old

AGE CATEGORY

36,000,000

People

Each Year

80%

MAJOR CAUSES

Cardiovascular Cancer

Respiratory Diabetes

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Probability of dying from NCDs

Deaths from NCDs, WHO

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Recourse in Hand, High Income Countries

62% 31%

High Income Countries own 62% world area, but only has 31% population

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Mortality: Total Deaths

Low Income Lower Middle Income

Upper Middle Income

High Income0%

10%

20%

30%

40%

50%

5.4%

33.9%

10.3%

13.9%

9.4%

14.9%

2.1%1.1%1.5%

5.1%1.4% 1.0%

NCDs Communicable diseases Injuries

Income was coded by World Bank Income Group.

TOTAL DEATHs NUMBER: 56,888,289 PERSONs

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Mortality: Major Causes of NCDs Deaths

CVD Cancer Respiratory Digestive NC Diabetes0%

10%

20%

30%

40%

50%

60%

48.0%

21.0%

11.7%6.1%

3.6% 3.5%

TOTAL NCDs DEATHs NUMBER: 36,121,872 PERSONs

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Mortality: China Data

Total CVD & DM Cancer Respiratory0

100

200

300

400

500

600

700

800

900

1,000

495

260

105 89

665

312

182

118

Female Male

Deaths per 100,000 (age-standardized estimate)

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Mortality: Total NCDs Deaths

Low Income Lower Middle Income

Upper Middle Income

High Income0%

10%

20%

30%

40%

50%

60%

70%

80%

4.1%

24.5%

7.9% 11.1%4.4%

28.9%

8.2%10.8%

8.6%

53.4%

16.2%21.9%

Female Male Total

Income was coded by World Bank Income Group.

TOTAL NCDs DEATHs NUMBER: 36,121,872 PERSONs

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Mortality: Cardiovascular

Low Income Lower Middle Income

Upper Middle Income

High Income0%

10%

20%

30%

40%

50%

60%

70%

80%

4.2%

25.5%

9.9% 10.3%4.2%

27.8%

9.2% 8.8%8.5%

53.3%

19.1% 19.1%

Female Male Total

Income was coded by World Bank Income Group.

TOTAL CVs DEATHs NUMBER: 18,582,231 PERSONs

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Mortality: Cancers

Low Income Lower Middle Income

Upper Middle Income

High Income0%

10%

20%

30%

40%

50%

60%

70%

80%

3.3%

20.1%

6.8%

17.6%

2.9%

27.1%

8.2%14.1%

6.2%

47.3%

14.9%

31.7%

Female Male Total

Income was coded by World Bank Income Group.

TOTAL CANCERs DEATHs NUMBER: 7,583,251 PERSONs

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Mortality: Chronic Respiratory Diseases

Low Income Lower Middle Income

Upper Middle Income

High Income0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3.4%

32.0%

3.4%6.7%4.7%

39.3%

4.9% 5.7%8.1%

71.2%

8.2%12.5%

Female Male Total

Income was coded by World Bank Income Group.

TOTAL CRDs DEATHs NUMBER: 4,233,863 PERSONs

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Mortality: Diabetes

Low Income Lower Middle Income

Upper Middle Income

High Income0%

10%

20%

30%

40%

50%

60%

70%

80%

6.8%

26.5%

11.5%8.9%

5.2%

22.8%

8.3% 10.1%12.0%

49.3%

19.8% 18.9%

Female Male Total

Income was coded by World Bank Income Group.

TOTAL DIABETES DEATHs NUMBER: 1,255,584 PERSONs

Risk Factors

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Tobacco

PhysicalInactive

HarmfulAlcohol use

Unhealthy Diet

Raised Blood Pressure

Malnutrition

RaisedCholesterol

Infection

Overweight Obesity

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Population-wide Interventions: Best Buys▀ Protecting people from tobacco and banning smoking in public places

▀ Warning about the dangers of tobacco use

▀ Enforcing bans on tobacco and alcohol advertising

▀ Raising taxes on tobacco and alcohol

▀ Restricting access to retailed alcohol

▀ Reduce salt intake and salt content of food

▀ Replacing trans-fat in food with polyunsaturated fat

▀ Promoting public awareness about diet and physical activity

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Tobacco Consumption

Europe Americas Africa West P SE Asia Eastern M CHINA LI LMI UMI HI0

2

4

6

8

10

12

14

11.5

7.5

5.2 5.1

2.01.0

5.6

3.8

5.2

8.59.0

TOTAL ADULT (15+ YEARS) PER CAPITA CONSUMPTION, 2008

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Tobacco Products Policies

• In 2010, Turkey became one of the 17 smoke-free countries in the world;

• Increased tobacco taxes by 77%, which led to a 62% price increase on cigarettes;

• Pictorial health warnings on tobacco packaging;

• A comprehensive ban on tobacco advertising;

• A comprehensive smoke-free law for all public and work places;

• Egypt increased taxes by 87% for cigarettes and 100% for loose

tobacco, lead to an increase of 44% in retail prices and a 21% reduction in cigarette consumption;

• Ukraine elevated taxes by 127%, leading to a 73% increase in retail prices between February 2009 and May 2010.

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Individual Health-care Interventions

▀ Ensure Early detection and using cost-effective and sustainable health-care interventions

▀ Counseling and multidrug therapy, including glycaemia control, and high risk of CVDs

▀ Screening for cervical cancer, once, at age 40

▀ Early case finding for breast cancer (50 – 70 years)

▀ Early detection of colorectal and oral cancer

▀ Treatment of persistent asthma

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Implementation of fiscal interventions to influence behaviour change, 2010

66%27%

7%

IMPLEMENTED, 127

NOT IMPLEMENTED, 53

NO DATA, 13

HIGH: ■■■■■■■■ 82.4%

LOW: ■■■■■■ 54.5%

LOWER MIDDLE:

■■■■■■ 58.5%

UPPER MIDDLE:

■■■■■■■ 66.7%

IMPLEMENTED DUE TO INCOME

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Availability implementation of guidelines for the management of hypertension, 2010

26%

39%

4%

23%

5%2% FULLY

IMPLEMENTED, 51PARTIALLY IMPLEMENTED, 76NOT IMPLEMENTED, 8NOT AVAILABLE, 45NO DATA, 9

UNKNOWN, 4

HIGH: ■■■■ 39.2%

LOW: ■ 9.1%

LOWER MIDDLE:

■■ 18.9%

UPPER MIDDLE:

■■■■ 37.8%

HIGH: ■■■■■■■ 68.6%

LOW: ■■■■ 38.6%

LOWER MIDDLE:

■■■■■■■ 71.7%

UPPER MIDDLE:

■■■■■■■■ 82.2%

FULLY IMPLEMENTED

FULLY + PARTIALLY IMPLEMENTED

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Availability implementation of guidelines for the management of Diabetes, 2010

30%

40%

4%

20%

5%2% FULLY

IMPLEMENTED, 58PARTIALLY IMPLEMENTED, 78NOT IMPLEMENTED, 7NOT AVAILABLE, 38NO DATA, 9

UNKNOWN, 3

HIGH: ■■■■■ 47.1%

LOW: ■ 11.4%

LOWER MIDDLE:

■■ 22.6%

UPPER MIDDLE:

■■■■ 37.8%

HIGH: ■■■■■■■ 78.4%

LOW: ■■■■ 43.2%

LOWER MIDDLE:

■■■■■■■ 77.4%

UPPER MIDDLE:

■■■■■■■■ 80.0%

FULLY IMPLEMENTED

FULLY + PARTIALLY IMPLEMENTED

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Individual Interventions in Diabetes with Evidence of EfficacyInterventions with evidence

of efficacyBenefit

Lifestyle interventions for preventing type 2diabetes in people at high risk

Reduction of 35–58% in incidence

Metformin for preventing type 2 diabetes forpeople at high risk

Reduction of 25–31% in incidence

Glycaemic control in people with HbA1cgreater than 9%

Reduction of 30% in microvascular disease

per 1 percent drop in HbA1cBlood pressure control in people whosepressure is higher than 130/80mmHg

Reduction of 35% in CVDs per 10 mmHg drop inblood pressure

Annual eye examinationsReduction of 60 to 70% in serious

vision loss

Foot care in people with high risk of ulcers

Reduction of 50 to 60% in serious foot disease

Angiotensin converting enzyme inhibitor usein all people with diabetes

Reduction of 42% in nephropathy; 22% drop

in cardiovascular disease

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The world has a sound vision and a clear road map to address NCDs

2000

2010

2003

2004

2008

Global Strategy for the Prevention and Control of

NCDs

WHO Framework Convention on Tobacco

Control

Global Strategy on Diet, Physical Activity and

Health

Action Plan for the Global Strategy for Prevention

and Control NCDs

Global Strategy to Reduce the Harmful Use

of Alcohol

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