Protecting Health from Old and New Threats Hanoi Medical University November 14, 2012 Thomas R....
-
Upload
alice-hamilton -
Category
Documents
-
view
215 -
download
0
Transcript of Protecting Health from Old and New Threats Hanoi Medical University November 14, 2012 Thomas R....
Protecting Health fromOld and New Threats
Hanoi Medical University
November 14, 2012
Thomas R. Frieden, MD, MPHDirector
Centers for Disease Control and Prevention
Infectious disease burden decreasing… but still cause >1/4 of all global deaths
• ~15 million deaths/year worldwide from all infectious diseases
• HIV, TB, pneumonia, diarrheal diseases, and malaria are leading infectious disease killers
• Disproportionally affect low-income countries
• Cause nearly 2/3 of all child deaths
• Most from pneumonia, diarrheal disease
• Influenza pandemics and emerging infectious diseases an increasing concern
Clean water and sanitation still abasic unmet need
• Nearly 800 million people still have no reliable access to clean water, 2.5 billion have no access to sanitation systems
• >2.5 million people die each year from water-borne infectious diseases – most of them children under age 5
• Each dollar spent on clean water/improved sanitation returns $10 in health & economic benefits
1.5M
d
eath
s
WHO, Global Burden of Disease 2008. Updated estimates
* vaccine preventable component caused by Streptococcus pneumoniae, Haemophilus influenzae type b, JE^, Japanese Encephalitis
Estimated vaccine-preventable disease deaths averted and still occurring
Annually among children <5 years, 2008
TB: 8.8M incident cases, 1.5M deaths worldwide in 2010
WHO. Global Tuberculosis Control: WHO Report 2011.
Prevalence
MDG target
WHO. Global Tuberculosis Control: WHO Report 2011.
Projected
TB prevalence and mortality rates are declining rapidly…
but incidence is barely declining
Mortality
MDG target
Projected
Incidence
Rat
es
per
100,
000
pop
ula
tion
Number of people living with HIV continues to increase…
even as new cases and deaths decline
UNAIDS. World AIDS Day Report 2011.
Artemisinin drug resistance isgrowing in South-East Asia
WHO. Update on artemisinin resistance, April 2012. Circles represent data before November 2010; triangles data after November 2010.
Percentage of cases positive for malaria on day 3 after ACT • Anti-malarial ACT
drug therapies increasingly ineffective
• No new drug class expected for >5 years
• Need for better control of malaria to
• Prevent worsening drug resistance
• Slow disease spread
Increasing risk of infectious disease from other sources
• Foodborne disease (from contaminated foods)
• May cause billions of illnesses and up to 1 million deaths each year
• Healthcare-associated infections (lack of basic hygiene, e.g., hand washing, sterilization)
• Affects about 1 in 10 patients (hundreds of millions of people/yr)
• Emerging diseases (new pathogens)
• West Nile virus, SARS, H5N1, ???
For the first time in human history…
• More people live in urban than rural areasMore people are overweight than underweightMore deaths occur among adults than childrenNon-communicable diseases (e.g., diabetes, heart disease, stroke) kill more people globally than infectious diseases
• Higher rates of NCDs in low/middle- than in high-income countries – rapid rise threatens economic/social development
40 years ago, there were about the same number of deaths worldwide among both
children and adults…Now, there are more than 3x as many deaths among adults as there are among children
The unfolding global pandemic
Non-Communicable Diseases•Heart disease, stroke•Cancer•Injuries•Obesity, diabetes•Chronic lung disease
Risk Factors•Tobacco•Inactivity•Nutrition•Alcohol
Global burden of tobacco
• Tobacco killed 100 million people worldwide in the 20thCentury
• Leading preventable cause of death – kills up to half of people who use it
• Unless urgent action is taken
• By 2030 tobacco will kill more than 8 million people each year – more than 80% of whom will be in developing countries
• Tobacco could kill 1 billion people during the 21st Century – unless we act now
Smoking and second-hand smoke damage every part of the body
Smoking
Second-Hand Smoke
World Health Organization
Tobacco is now the world’s leading single agent of death
Tobacco kills more people worldwide each year than HIV, TB, and malaria combined
No more than 10% of the world’s peopleare covered by even a single effective
tobacco control policy
9% or less benefit from effective interventions to reduce use
Share of world population
World Health Organization
Global Tobacco Surveillance System
• Enhance country capacity to design, implement and evaluate tobacco control interventions
• Monitor key articles of WHO Framework Convention on Tobacco Control (FCTC) and components of the WHO MPOWER technical package
• Includes collection of data through four surveys:
• Global Youth Tobacco Survey
• Global School Personnel Survey
• Global Health Professions Student Survey
• Global Adult Tobacco Survey
Smoke-free laws save lives and don’t hurt business
• Save lives and prevent heart attacks• Up to 17% average reduction in heart
attack hospitalizations in places with smoke-free laws
• Help motivate smokers to quit• Worker safety issue, not “personal
nuisance”• Allworkers deserve equal protection• Only way to protect non-smokers from
secondhand smoke
• Smoke-free workplace laws don’t hurt business• No trade-off between health and economics
Active liquor licenses and restaurant/bar employment increased in NYC after
implementation of SFAA
License Data: State Liquor Authority data on all active licenses. Employment Data: NYC Economic Development Corp.Average annual employment calculated from monthly totals.
SFAA effective3/03
Warn about the dangers of tobacco
• Despite overwhelming evidence of the dangers of tobacco, most people are unaware of the full extent of health risks of tobacco use and secondhand smoke exposure
Brazilian pack warning
• Graphic, pictorial pack warnings are effective in encouraging cessation
• Media efforts help change image of smoking:
• Anti-tobacco advertising through mass media campaigns
• Obtain free media coverage of anti-tobacco activities
Enforce bans on tobacco advertising, promotion, and sponsorship
• Tens of billions of dollars spent annually on tobacco marketing and promotion
• Tobacco control expenditures just a small fraction of this total
• Need to ban all advertising in all media
• Including at point-of-sale
• Need to ban all promotions and sponsorships
Street in Indonesia, before and after ad ban
Plain (generic) packaging prevents use of package
as a marketing device
Tobacco taxes reduceconsumptionRelationship between cigarette consumption
and excise tax rate in South Africa
Source: van Walbeek C. Tobacco excise taxation in South Africa: tools for advancing tobacco control in the XXIst century: success stories and lessons learned. Geneva, World Health Organization, 2003. Additional information obtained from personal communication with C. van Walbeek.
MPOWER interventions reduced smoking prevalence in Uruguay
• One of the sharpest declines ever reported
• Coordinated package of interventions• Smoking ban (first
country in Americas to go 100% smoke-free)
• Comprehensive ad ban• Large pictorial warning
labels• Cessation services• High taxes Data: Global Adult Tobacco Survey
1 in 4 smokers quit
Heart disease and stroke will continueto kill the most people worldwide
2004(actual)
2030(projected)
Proportion of people worldwide who die from heart disease and stroke is unlikely to change over the next two decades
Clinical and public health progress contributed about equally to decreased
US heart disease deaths, 1980-2000
Phy
sica
l in
activ
ity
Sec
onda
ry p
reve
ntiv
e th
erap
ies
Initi
al tr
eatm
ents
for
hear
t att
ack
or
acut
e an
gina
Trea
tmen
ts fo
r
hear
t fai
lure
Rev
ascu
lari
zatio
n
for
chro
nic
angi
naHTN
,S
tatin
s
Cho
lest
erol
re
duct
ion
Sys
tolic
BP
red
uctio
n
Sm
okin
gre
duct
ion
Ford ES, et al. NEJM 2007:356;23.
Clinical interventions = ~50%
Risk factor reductions = ~50%
BM
I inc
reas
esD
iabe
tes
incr
ease
s
Changes in CHD risk factors contributed79% of life-years gainedEngland & Wales, 1981-2000
Unal B, et al. AJPH 2005;95:103-108.
67 million US adults havehigh blood pressure…
but less than half have it controlled
CDC Vital Signs, Sept. 2012; NHANES 2003-2010.
67M
53M47M
31M
47%
Hypertension control in Canada,the UK, and the US
Data for Canada: McAlister et al. CMAJ 2011;183:1007-1013.Data for UK: Ramsey et al. BMJ 1999; 319:630-635.Data for US:CDC Vital Signs, Sept. 2012; NHANES 2003-2010.
Percentage of people with hypertension who have their condition under control
Ontario, Canada
US
UK
Million Hearts: Prevent 1Mheart attacks and strokes in US by 2017
Road Traffic SafetyA winnable battle in global public health
• Large and growing burden • Road traffic accidents kill
1.2 million, injure up to 50 million annually worldwide
• Epidemic is still increasing in most parts of the world
• Legal interventions are proven effective
• Relatively inexpensive and highly cost-effective
Road traffic injuries to be 5th leading cause of death globally by 2030
2004(actual)
2030(projected)
Road traffic crashes currently cause more than 1.3 million deaths a year – but by 2030 will kill an estimated 2.4 million people per year
Evidence-based interventionsOnly 15% of countries have sufficiently comprehensive
road safety laws covering all five critical safety risk factors
• Drunk driving– BAC limits
• Seatbelts– drivers and passengers
• Child restraints– age/weight limits; safety standards
• Helmets– riders and passengers (also bicycles); safety standards
• Speed limits– under 50 km/h in urban areas
Rapid detection & characterization
Scalableresponse Recovery
Core attributes of NPHIs
• National scope of influence
• National recognition
• Scientific basis
• Shielded from political influence
• Focus on major public health problems
• Adequate human and financial resources
• Adequate infrastructure support
• Linkages and networks
• Accountability
Role of NPHIs
• Monitor and respond to health threats• Provide information, oversight, and program
implementation• Coordinate public health strategy, policy advice,
and program delivery• Need to adapt to meet new challenges
• Increasing complexity of health care• Budgetary constraints• New and emerging infectious disease threats• Growing burdens of NCDs diseases and injuries
• Success depends on accurate collection, analysis, and dissemination of data to improve health
Public health is local…so NPHI relationships with local
agencies are critical
• Strong relationships and successful engagement with subnational/local agencies• Depends on whether direct supervisory
role over local or if local has greater autonomy
• Level of subnational public health support• Funds and personnel (long/short term)• Reference laboratory services• More comprehensive oversight and
support
Field Epidemiology Training Programs
• Two-year, full-time postgraduate program• Modeled after CDC’s Epidemic
Intelligence Service
• Since 1980, 41 FETPs trained >2,600 epidemiologists• Residents assigned to positions
that provide epidemiologic service to MOH
• >80% stay in-country after graduating
• Effective, low-cost, practical – but has trained only small proportion of numbers needed
Global Disease Detection and Emergency Response
Helping people when they need help most
• Response to disease outbreaks and complex emergencies around the world
• Monitor, detect, and contain emerging health threats
• Re-establish and strengthen public health systems in wake of catastrophic events
• Deploy CDC experts 24/7 at country request
Healthier, safer, longer, andmore productive lives worldwide
Healthier, safer, longer, andmore productive lives worldwide