Overview of Non-Communicable Diseases

Feisul Idzwan Mustapha MBBS, MPH, AM(M)

Public Health Physician, NCD Section, Disease Control DivisionMinistry of Health, Malaysia

LeAd-NCD-MAL Workshop1 December 2014

Klang

dr.feisul@moh.gov.my

Ministry of Health

Malaysia

There are Four Major Groups of Non-Communicable Diseases;Four major lifestyles related risk factors

Modifiable causative risk factors

Tobacco useUnhealthy

diets

Physical

inactivity

Harmful

use of

alcohol

No

nco

mm

un

icab

le disea

ses

Heart disease

and stroke

Diabetes

Cancers

Chronic lung

disease 2

3

Source of icons: World Heart Federation Champion Advocates Programme

Global NCD

Targets

Proportional mortality, Malaysia (% of total deaths, all ages, both sexes)

4

Premature mortality due to NCDs, Malaysia

5

The probability of dying between ages 30 and 70 years from the 4 main NCDs is 20%

DALYs attributable to risk factors

6

10.8%

10.7%

9.0%

8.3%

5.2%

4.3%

3.1%

0.7%

0.1%

10.8%

0.7%

11.4%

12.1%

5.1%

0.9%

4.3%

0.7%

0.1%

15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%

High BP

Tobacco

Diabetes Mellitus

High BMI

High Cholesterol

Alcohol

Physical Inactivity

Underweight

Poor Water & Sanitation

Male Female

Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

19.4%

15.7%

8.5%

7.3%

7.0%

5.0%

2.3%

0.2%

0.1%

22.8%

1.2%

9.1%

8.1%

8.2%

7.1%

0.3%

0.2%

0.1%

25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%

High BP

Tobacco

Diabetes Mellitus

High Cholesterol

High BMI

Physical Inactivity

Alcohol

Underweight

Poor Water & Sanitation

Male Female

Deaths attributable to risk factors

Burden of Disease Study Malaysia 2008, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

7

Sub-analysis of NHMS 2011 data

• At least 15% (18 years and above) already with known NCD risk factors (diabetes, hypertension or hypercholesterolemia).

• Undiagnosed high blood sugar, high blood pressure or high cholesterol: 42.1% (18 years and above).

• Or, if include obesity: 48.3% (18 years and above).

• Therefore our high risk and at risk population: 63.3% (18 years and above)

8

9

Source of icons: World Heart Federation Champion Advocates Programme

Global NCD

Targets

10

65th World Health

Assembly (May 2012):

Decided to adopt a global target of a 25% reduction in premature mortality from NCD by 2025.

66th World Health Assembly (May 2013):

Adoption of the Global Action plan for the Prevention and Control of NCDs (2013-2020), including 25 NCD indicators with 9 voluntary global targets.

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First High-level Meeting on NCDs (New York, 19-20 September 2011)

2011

Second high-level Meeting on NCDs (New York, 10-11 July 2014) to take stock of the progress made since 2011

2014

Third High-level Meeting on NCDs to report on progress achieved since 2014

2018

Outcome Document of the 2014 UN General Assembly High-level Meeting on NCDs

12

Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

2014 UN Outcome Document on NCDs(resolution A/RES/68/300)

• Bottom line: Governments committed themselves to intensify their efforts towards a world free of the avoidable burden of NCDs

• Moving forward: Maps out a set of concrete national commitments to be implemented between 2014 and 2018, and provides 3 new global assignments

• Towards the world we want: Next milestone in 2018

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Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

National commitments included in the 2014 UN Outcome Document on NCDs

By 2015, consider setting national targets for NCDs

By 2015, consider developing national multisectoral policies and plans

Integrate NCDs into health-planning and national development plans

By 2016, implement "best buys" to reduce risk factors for NCDs

By 2016, implement "best buys" to enable health systems to respond

Strengthen national surveillance systems

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Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

Global assignments included in the 2014 UN Outcome Document on NCDs

By 2015, WHO to develop an approach to register and publish contributions of non-State actors towards the 9 global NCD targets

WHA68: Framework for country action to mobilize sectors beyond health

OECD/DAC: Purpose code to track development assistance for NCDs

By 2017, WHO to submit a progress report to UN General Assembly

By 2018, UN General Assembly to convene a third High-level Meeting

15

Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

Global accountability framework for NCDs:Milestones during the next three years

• WHO publishes global baseline

• WHO conducts third survey on national capacities

• WHO generates data2015

• Progress report to WHA on 25 outcome indicators

• Progress report to WHA on 9 progress indicators2016

• Independent evaluation (Global Action Plan)

• Progress report to the UN General Assembly2017 16

Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

NCDs in the post-2015 development agenda: Towards the world we want

• 10 September 2014: Member States welcomed the report of the Open Working Group of the UN General Assembly on Sustainable Development Goals

• Next 12 months: Proposal shall be the main basis for integrating sustainable development goals into the post-2015 development agenda

• Target 3.4: By 2030 reduce by one-third pre-mature mortality from NCDs through prevention and treatment, and promote mental health and well-being

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Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

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Cost effective interventions to address NCDs

Population-based interventions addressing NCD risk factors

Tobacco use - Excise tax increases- Smoke-free indoor workplaces and public places- Health information and warnings about tobacco- Bans on advertising and promotion

Harmful use of alcohol

- Excise tax increases on alcoholic beverages- Comprehensive restrictions and bans on alcohol marketing- Restrictions on the availability of retailed alcohol

Unhealthy diet and physical inactivity

- Salt reduction through mass media campaigns and reduced saltcontent in processed foods

- Replacement of trans-fats with polyunsaturated fats- Public awareness programme about diet and physical activity

Individual-based interventionsaddressing NCDs in primary care

Cancer - Prevention of liver cancer through hepatitis B immunization- Prevention of cervical cancer through screening (visual

inspection with acetic acid [VIA]) and treatment of pre-cancerous lesions

CVD and diabetes

- Multi-drug therapy (including glycaemic control for diabetes mellitus) for individuals who have had a heart attack or stroke, and to persons at high risk (> 30%) of a cardiovascular event within 10 years

- Providing aspirin to people having an acute heart attack

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Cost effective NCD interventions…

• What works, what can we afford, and what should we adopt?

• The challenge? Identify interventions that:• are effective;• can lead to measurable declines in NCD death rates

quickly (e.g. over 10 years);• are affordable; and• can easily be implemented and sustained.

The Lancet. December 8, 2007 Volume 370:Gaziano T, Galea G and Reddy K. Scaling up interventions for chronic disease prevention: the evidence. pp 1939-1946.

The Lancet. December 15, 2007. Volume 370:Asaria P, Crisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. pp 2044-2053.Lim S, et. al. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs. pp 2054-2061.

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2000

2001-03

2004-06

2008

2009-11

Healthy Islands Initiative WPDD Call for Action on Obesity ControlRegional plan for integrated CVD and Diabetes Prevention 1998-2003

Regional Tobacco action plan FCTC implementationRegional NCD STEP Surveys

Healthy Cities Initiatives addressing NCD and tobaccoNCD & Poverty: Pro-Poor Strategy 2006

Regional Action plans for NCD Regional Strategy to ReduceAlcohol related harm

Regional Initiative on multi-sectoralintervention for NCD prevention: Obesity Strategy & programme: Breast/cervical cancer control

2012National multisectoral plansMarketing of foods/ NCD and PHC/Surveillance

2013 Cancer Leadership and LeAd-NCDRegional action plan (2014-2020)

2014NCD knowledge net work2nd Lead NCDNCD surveillance

WHO Regional Response

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Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

National Strategic Plan for

Non-Communicable Diseases

(NSP-NCD) 2010-2014

• Presented and approved by the Cabinet on 17

December 2010.

• Provides the framework for strengthening NCD

prevention & control program in Malaysia.

• Adopts the “whole-of-government” and

“whole-of-society approach”.

• Diabetes & obesity are used as the entry

points.

Seven Strategies:1. Prevention and

Promotion

2. Clinical Management

3. Increasing Patient

Compliance

4. Action with NGOs,

Professional Bodies &

Other Stakeholders

5. Monitoring, Research

and Surveillance

6. Capacity Building

7. Policy and Regulatory

interventions

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Strategy 7 NSP-NCD: Policy & Regulatory Interventions• Main thrust of NSP-NCD

• Health promotion and education will increase awareness and knowledge

• However changes in behaviour is strongly influenced by our living environment

Awareness KnowledgeBehavioural

Change

Supportive living environment

Health promotion & educations

Policies & regulations23

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The Great Prevention Debate

Personal choice

versus

government responsibility

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Personal Choice is Important

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BUT … If we want people to make healthy choices we have to make healthy choices available, accessible and affordable

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Prevention is BOTH a personal and

government responsibility

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Social Determinants of Health

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National Systems Response to NCDs –ASEAN Countries

BR

N

CA

M

IND

LAO

MA

L

MY

N

PH

I

SIN

THA

VIE

T

Has an operational NCD unit/branch or department within MOH ✓ ✓ ✓ ✗ ✓ ✗ ✓ ✓ ✓ ✗

Has an operational multisectoral & integrated national policy, strategy or action plan ✗ ✗ ✓ ✗ ✓ ✓ ✗ ✗ ✗ ✗

Has an operational policy, strategy or action plan to reduce the harmful use of alcohol ✓ ✓ ✓ ✗ ✗ ✓ ✓ ✗ ✓ ✗

Has an operational policy, strategy or action plan to reduce physical inactivity ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✗

Has an operational policy, strategy or action plan to reduce the burden of tobacco use ✗ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓

Has an operational policy, strategy or action plan to reduce unhealthy diet and/or promote healthy diets ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✓

Has evidence-based national guidelines for the Mx of major NCDs through a primary care approach ✓ ✗ ✓ ✗ ✓ ✓ ✗ ✓ ✓ ✗

Has an NCD surveillance and monitoring system in place to enable reporting for the GMF ✗ ✓ ✗ ✗ ✓ ✗ ✗ ✓ ✓ ✓

Has a national, population-based cancer registry ✓ ✗ ✗ ✗ ✗ ✗ ✗ ✓ ✗ ✗

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Summary

• Preventing and controlling NCD is an urgent priority for all countries.

• NCD is a global issue – affecting not just developed countries, but more so in developing countries.

• Most of the drivers of NCDs and their risk factors lie outside the control of the health sector.

• Multi-Sectoral Approach (MSA) is required to create enabling environments, so that healthy choices are the easy choices.

• MSA is also required to break the cycle of poverty and NCDs.• The prevention and control of NCDs and their risk factors have

a positive impact not only on health, but also on productivity and economic and social development.

• The burden of NCD in Malaysia continues to increase.• Prevention and control of NCDs is both the responsibility of

government as well as individuals.31

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Summary

Thank you

dr.feisul@moh.gov.my

Facebook: Feisul Mustapha33