Non-Communicable Diseases Control Program

_________________________________

K R Thankappan MD, MPH Additional Professor and Head

Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and

Technology, Trivandrum

Injuries (9.1%)

Noncommunicableconditions (59.8%)

Death, by broad cause group, 1999

Communicable diseases, maternal and perinatal

conditions and nutritional deficiencies (31.1%)

Source: WHO Report 2000

Injuries (13.9%)

Noncommunicableconditions (43.2%)

Global burden of diseasein disability-adjusted life years (DALYs), 1999

Communicable diseases, maternal and perinatal

conditions and nutritional deficiencies (42.8%)

Source: WHO Report 2000

Deaths, by broad cause group and WHO Region, 1999

AFR EMR EURSEAR WPR AMR

25

50

75

%

Communicable diseases, maternal and perinatal conditions and nutritional deficiencies

Noncommunicableconditions

Injuries

Source: WHO 2000

DALYS, by broad cause group and WHO Region, 1999

AFR EMR EURSEAR WPR AMR

DALY = Disability adjusted life-year

Communicable diseases, maternal and perinatal conditions and nutritional deficiencies

Noncommunicableconditions

Injuries

25

50

75%

Source: WHO 2000

Source: WHO, Evidence, Information and Policy, 2000

1990 2020

DALY = Disability-Adjusted Life Year

Communicable diseases, maternal and perinatal conditions and nutritional

deficiencies

Noncommunicable conditions

Neuropsychiatric disorders

Injuries

43

14

22

21

49

27

15

9

% %

DALYs, by broad cause group 1990 - 2020in developing countries (baseline scenario)

Low- and middle-income countries suffer the greatest impact on non-communicable diseases

77% of the total number of deaths attributable to NCDs

occurred in developing countries

85% of the global NCD disease burden borne by low- and middle-income countries

Source: WHO:, 2000

Malaria (69)HIV/AIDS (360)

Tuberculosis (723)

Diarrhoeal diseases (978)

Injuries (1301)

Noncommunicableconditions (7370)

Maternal conditions (158)Childhood diseases (542)

Respiratory infections (1523)

Distribution of causes of deathin South-East Asia, 1999 (000s)

Other causes (236)

Nutritional deficiencies (159)Perinatal conditions (851)

Source: WHO 2000

Malaria (3071)HIV/AIDS (8866)Tuberculosis (14101)

Diarrhoeal diseases (30017)

Injuries (65289)

Noncommunicableconditions (156536)

Maternal conditions (7733)Childhood diseases (19449)

Respiratory infections (38144)

Other causes (19693)

Burden of diseasein disability-adjusted life years (DALYs)

in South-East Asia,1999 (000s)

Nutritional deficiencies (16866)

Perinatal conditions (32715)

Source: WHO 2000

Cardiovascular (CVD) epidemicin countries of different stages of development

-----1940-----1950-----1960-----1970-----1980-----1990-----2000-----High

IncomeEconomies

Economiesin

Transition

Slow

increaseRapid

increase

Reachthe peakin some

countries

Middleand Low

IncomeCountries

First causeof death & disability

Lowrates

Slowincrease

Rapidincreasein most

countries

First causeof death & disability inmost countries

Reachthe peak

Progressivedecline

Rapidincrease

Remains as first causeof death & disability

25

50

%

Communicable diseases, maternal and perinatal conditions and

nutritional deficiencies

Injuries

DALYs, by broad cause group 1990 - 2020in developing countries (baseline scenario)

DALY = Disability adjusted life-year

1990

2020

Source: WHO, Evidence, Information and Policy, 2000

Noncommunicableconditions

Epidemiological Transition in India

0%10%

20%30%

40%50%

60%

1990 2020

PreTransitional

NCD

Source: K S Reddy. Lancet 1998.

Coronary Heart Disease Prevalence Studies in India (Urban)Study Year Sample CHD PrevalenceAgra 1960 1046 11 1.05Delhi 1962 1642 17 1.04Chandigarh 1968 2030 134 6.60Rohtak 1975 1407 51 3.63Delhi 1990 13723 1327 9.67Jaipur 1995 2212 168 7.59Moradabad 1995 152 13 8.55Trivandrum 1995 506 41 12.65________________________Source: Gupta et al. Indian Heart Journal 1995.

Prevalence Of Hypertension in the elderly

Loacation % 95% CI

Kerala Urban 69 (63-75)Kerala Rural 55 (49-61)Maharashtra Urban 72 (69-75) Dhaka Urban 65 (62-67)Dhaka Rural 53 (47-59)

___________________________________Source. Hypertension study group AMCHSS of SCTIMST. WHO Bulletin 2001.

Prevalence of Hypertension (40-60 Yrs)Trivandrum City

Age group Prevalence40-44 42.245-49 55.350-54 55.755-60 67.2

Total 54.5Manu Zachariah, Thankappan K R et al. Indian Heart Journal 2003

• Smoking• Unhealthy diet -High in saturated fat & salt -Inadequate intake of fruits and vegetables • Excessive alcohol use• Sedentary life-style

BehaviouralRisk Factors

• Hypertensive heart disease• Coronary heart disease• Cerebrovascular disease (Stroke)• Peripheral vascular disease

Endpoints

Cardiovascular risk factorsNon-modifiable

Risk Factors•Age

•Male gender •Genetic

predisposition

ModifiableRisk

Factors•Hypertension

•Elevated LDL cholesterol

•Decreased HDL cholesterol

•Diabetes

• Insulin resistance

•ObesityAdverse

Socio-economic, Cultural & Environmental

Conditions

8.4 million

3 million

Established Market Economies

Middle Eastern CrescentLatin America & CaribbeanSub-Saharan AfricaOther Asia and Islands

China

India

Former Socialist Countries

Tobacco: deaths by World Bank regionsestimates for 1990 and 2020

Source: Murray CJL, Lopez AD 1996

1990 2020

Tobacco use and educational level among females in Bombay

1992-1994

Source: Gupta, 1996

5239.5

23.910

72.2

0

20

40

60

80

Users %

Body Mass Index in Indian Women 15-49 Years.State BMI <18.5 BMI 25+ BMI 30+

Delhi 12.0 33.8 9.2Punjab 16.9 30.2 9.1Kerala 18.7 20.6 3.8Orissa 48.0 04.4 0.6Assam 27.1 04.2 0.7Bihar 39.3 03.7 0.5India 35.8 10.6 2.2Urban 22.6 23.5 5.8Rural 40.6 05.9 0.9Source: NFHS 1998-99.

No National Program for NCD

More than 50% of disease burden in India is due to NCDs

Many National Programs for Communicable diseases

How to address

Monitoring of Risk factors

Tobacco UseDiet (Fruits and Vegetables)Body Mass IndexPhysical activityBlood SugarBlood Lipid levels

Disease Specific Program

CancerDiabetes

Bronchial AsthmaHypertension?

Need to develop a Program

Sentinel Health Monitoring Centres

AssamDelhi

Kerala MaharashtraTamil Nadu

Address Risk factors and determinants

at community level Inter-sectoral coordination

Legislation

For example Tobacco ControlAlcohol

Diet, salt restrictionExercise

Global strategy for Diet and Physical activity

Primary Health Care System

Need to re-orient focusTraining of health workers

Monitoring of blood pressure and urine sugar can be done at grass

root levelHealth education programs

Capacity Building

Manpower -PH specialistsNew Public Health Schools Social Science componentsMPH-SCTIMST, AllahabadPGI Chandigarh, CMC Vellore, EHAExpand the current MD programsFETP Programs- MAE at NIE

Start From Children

THANK YOU