1 / 51

WHO long-term strategy for prevention and control of leading chronic diseases

WHO long-term strategy for prevention and control of leading chronic diseases. Derek Yach Representative of the Director-General World Health Organization. Scope and approach. Exclude mental health (except in relation to co-morbidity) and injuries

baina
Télécharger la présentation

WHO long-term strategy for prevention and control of leading chronic diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. WHO long-term strategy for prevention and controlof leading chronic diseases Derek YachRepresentative of the Director-GeneralWorld Health Organization Cambridge International Health Leadership Programme; April, 25th 2004

  2. Scope and approach • Exclude mental health (except in relation to co-morbidity) and injuries • Include mainly 4 big killers-CVD, cancer, chronic respiratory disease and diabetes, and 3 major risks-tobacco, diet and physical activity Cambridge International Health Leadership Programme; April, 25th 2004

  3. Current health impact... Cambridge International Health Leadership Programme; April, 25th 2004

  4. 2279 1331 1037 811 783 672 475 382 352 343 Leading causes of mortalityfor adults, 2002 15–59 60 and over HIV/AIDS Ischaemic heart disease Tuberculosis Road traffic accidents Cerebrovascular disease Self-inflicted injuries Violence Cirrhosis of the liver Lower respiratory infections Chronic obstruc. pulmonary disease 5823 4692 2399 1398 929 754 735 606 496 478 Ischaemic heart disease Cerebrovascular disease Chronic obstruc. pulmonary disease Lower respiratory infections Trachea, bronchus, lung cancers Diabetes mellitus Hypertensive heart disease Stomach cancer Tuberculosis Colon and rectal cancers Cambridge International Health Leadership Programme; April, 25th 2004 Source: WHO, WHR, 2003

  5. Deaths due to Tuberculosis, Malaria and CVD in WHO Regions in 2002 thousands Cambridge International Health Leadership Programme; April, 25th 2004 Source: WHR 2003

  6. Cancers, age-specific death rates in China (urban & rural combined),1986 & 1999 Source: Bumgarner, 2003 Cambridge International Health Leadership Programme; April, 25th 2004

  7. Deaths in South Africa, 2000: men Cambridge International Health Leadership Programme; April, 25th 2004

  8. Risk factors are accumulating throughout the life course Cambridge International Health Leadership Programme; April, 25th 2004

  9. FetalLife InfancyandChildhood Adolescence Adult Life 1 2 3 4 Accumulated NCDRisk Age Age A Life Course Approach to NCD Prevention Development of NCD Cambridge International Health Leadership Programme; April, 25th 2004

  10. High blood pressure Tobacco High cholesterol Underweight Unsafe sex Low fruit and vegetable intake High BMI Physical inactivity Alcohol Unsafe water, sanitation, and hygiene High-mortality developing Indoor smoke from solid fuels Lower-mortality developing Iron deficiency Urban air pollution Developed Zinc deficiency Vitamin A deficiency Unsafe health care injections Occupational risk factors for injury Occupational particulates Lead exposure Illicit drugs 0 1000 2000 3000 4000 5000 6000 7000 8000 Attributable mortality in thousands (Total 55,861) Attributable Mortality (20 leading risk factors) Cambridge International Health Leadership Programme; April, 25th 2004

  11. Trends in mean total cholesterol; Beijing China, 25-64 Mean total cholesterol mmol/l Cambridge International Health Leadership Programme; April, 25th 2004 Source: Subnational, Beijing, MONICA

  12. % of students aged 13-15who smoke cigarettes Boys currently smoke cigarettes Girls currently smoke cigarettes Boys/Girls ratio Overall / Median 15.0 6.6 1.9:1.0 Africa 10.4 4.6 2.2:1.0 Burkina Faso 28.6 9.6 3.0:1.0 South Africa 21.0 10.6 2.0:1.0 The Americas 16.6 12.2 1.2:1.0 Columbia 31.0 33.4 0.9:1.0 United States 17.7 17.8 1.0:1.0 Eastern Mediterranean 22.8 5.3 4.3:1.0 Jordan 22.0 9.9 2.2:1.0 Europe 33.9 29.0 1.2:1.0 Bulgaria 26.0 39.4 0.7:1.0 Czech Republic 34.0 35.1 1.0:1.0 Southeast Asia 13.5 3.2 4.2:1.0 Indonesia 38.9 4.7 8.3:1.0 Myanmar 19.0 3.2 5.9:1.0 Western Pacific 11.0 6.4 1.7:1.0 Palau 20.0 23.3 0.9:1.0 Source: Global Youth Tobacco Survey Cambridge International Health Leadership Programme; April, 25th 2004

  13. Trends of overweight in children Trends of overweight in children Source: de Onis and Blössner. Am. J. Clin. Nutr. 2000; 72: 1032-9 Cambridge International Health Leadership Programme; April, 25th 2004

  14. Future burden of chronic diseases will reflect accumulation of risk Cambridge International Health Leadership Programme; April, 25th 2004

  15. Global Chronic Disease Burden1990-2020 (by disease group in developing countries) 1990 2020(baseline scenario) Cambridge International Health Leadership Programme; April, 25th 2004

  16. Prevalence of diabetes mellitus in adults (>20 years) in 2000 and projections for 2030 % Cambridge International Health Leadership Programme; April, 25th 2004

  17. …and impact on the long-term emergence of health inequalities Smoking prevalence among men in Chennai (India) by education levels Cambridge International Health Leadership Programme; April, 25th 2004

  18. Economic Impact… Cambridge International Health Leadership Programme; April, 25th 2004

  19. Costs to the economy: Tobacco Tobacco has many negative economic impacts: • Health care costs • Fires: Annual cost of fires caused by smoking is US$27 billion • Absenteeism: In the US, smokers take of an average of 6.16 sick days per year compared with 3.86 of people who have never smoked; in 1994, it costs Telecom Australia $16.5 million in costs of loss of time off work • Cumulative costs on the workplace: In the USA, workplace smoking costs $47 billion every year. • Trash collection: 20% of all trash collected in the US is cigarette butts Source: Mackay and Eriksen, 2002 Cambridge International Health Leadership Programme; April, 25th 2004

  20. Economic costs of diet-related chronic diseases in China & India Cambridge International Health Leadership Programme; April, 25th 2004

  21. Chronic diseases impact national economies and pose risks for private foreign investors "The following report on cardiovascular disease estimates that 6 million years of potentially productive life are lost in China each year because of heart disease and stroke. Thus, countries experience the economic impact of these cardiovascular disorders far beyond the health portfolio, including in industry and commerce, in households and in communities." Jeffrey Sachs A Race Against Time: The Challenge Of Cardiovascular Disease In Developing Economies The Earth Institute and Mailman School of Public Health, Columbia University, New York (2004) Cambridge International Health Leadership Programme; April, 25th 2004

  22. Economic growth is an underlying determinant of chronic diseases Cambridge International Health Leadership Programme; April, 25th 2004

  23. Economic/Fiscal Legislate/Regulate Global action Pro-poor Unhealthy consumption - development and policy options High Observed pattern Prevalence of unhealthy consumption Desired path Low High Socio-economic Development Cambridge International Health Leadership Programme; April, 25th 2004

  24. Urban Rural 80 70 60 50 % Overweight in Urban and Rural Women 40 30 20 10 0 0 500 1000 1500 2000 2500 3000 3500 4000 4500 GNI Overweight-plus-obesity Prevalence in Women 20-49 by Gross National Income Cambridge International Health Leadership Programme; April, 25th 2004

  25. Risk factors are being transmitted by globalisation... Cambridge International Health Leadership Programme; April, 25th 2004

  26. Trade Trade of cigarettes out of and into the United States Cambridge International Health Leadership Programme; April, 25th 2004

  27. Foreign Direct Investment (FDI) Foreign assets, sales and employment of tobacco, alcohol, food, retail companies in the worlds largest 100 TNCs, 2001, ranked by foreign assets (US$ billion) Sector Corporation Home economy Foreign Assets (rank) US$ billion Foreign employment Food/Beverage Hutchinson Whampoa Limited Nestle SA Unilever Diageo Proctor & Gamble Coca-Cola Company McDonalds Danone Group SA Hong Kong Switzerland UK/Netherlands UK USA USA USA France 40.9 (17) 33.1 (21) 30.5 (25) 19.7 (47) 17.3 (58) 17.1 (59) 12.8 (79) 11.4 (86) 53 478 223,000 204,000 60 000 43 381 26 000 251,000 88,000 Retail (Food & Drink) Carrefour SA Wal-Mart Stores Royal Ahold NV France USA Netherlands 29.3 (29) 26.3 (24) 19.9 (44) 235 894 303 000 183 851 Alcohol Diageo UK 19.7 (47) 60 000 Tobacco Phillip Morris BAT USA UK 19.3 (49) 10.4 (92) 39,000 59 000 11 automobile and 10 pharmaceutical companies are also amongst the top 100 TNCs Source: UNCTAD, 2003 Cambridge International Health Leadership Programme; April, 25th 2004

  28. Marketing Cambridge International Health Leadership Programme; April, 25th 2004

  29. Urbanisation Estimated projected urban and rural populations in the world, 1950-2030 Cambridge International Health Leadership Programme; April, 25th 2004

  30. Urbanisation, lifestyles and chronic diseases Risk factors and trends Obesity Tobaccouse Physical activity Cambridge International Health Leadership Programme; April, 25th 2004

  31. Unhealthy consumption patterns threaten sustainable development Unhealthy consumption Some associated impact on sustainable development Lack of physical activity More motorised transport; increased vehicular pollution; destroyed landscapes and cities High-fat diets Grain for animals not humans; animal husbandry erodes fragile farmland Tobacco use Deforestation, pesticide residues Cambridge International Health Leadership Programme; April, 25th 2004

  32. Interventions exist and are cost effective but… Cambridge International Health Leadership Programme; April, 25th 2004

  33. Many impediments to progress... Cambridge International Health Leadership Programme; April, 25th 2004

  34. Pervasive myths Global economic development will improve all health conditions Chronic diseases result from freely adopted risks Chronic diseases are diseases of the elderly Chronic diseases are diseases of affluence Benefits of chronic disease control accrue only to the individual Infectious disease models are applicable to chronic diseases We can wait till infectious diseases are controlled Screening and treating patients in the health sector is a cost effective prevention strategy Cambridge International Health Leadership Programme; April, 25th 2004

  35. Weak capacity Percentage of countries with specific capacity indicators for NCD prevention and control Cambridge International Health Leadership Programme; April, 25th 2004

  36. Powerful interests block progress… Cambridge International Health Leadership Programme; April, 25th 2004

  37. tobacco company activities revealed in WHO inquiry “WHO...the leading enemy” “attack WHO...discredit key individuals” “contain, neutralize, reorient WHO” Cambridge International Health Leadership Programme; April, 25th 2004

  38. Cambridge International Health Leadership Programme; April, 25th 2004

  39. World Bank loans for chronic diseases 2.5 % of their $4.2 billion total to health, population and nutrition between 1997 and 2002 World Bank and Regional Development Banks No comprehensive policy on chronic disease (though currently developing a policy note) WB Health, Nutrition and Population strategy paper recognises impact of chronic disease on poor populations (eight of the existing 31 PRSPs include chronic diseases or risk factors in their action/expenditure plans or monitoring/evaluation indicators) RDBs have health sector strategies (but concentrate on communicable diseases) Cambridge International Health Leadership Programme; April, 25th 2004

  40. $2.9 billion 0.1% Official Overseas Development Aid to the health sector in 2002 allocated tochronic diseases (including mental health) International Donors Increased health support by donors mostly directed towards HIV/AIDS, not chronic diseases Cambridge International Health Leadership Programme; April, 25th 2004

  41. Current status of key players Heads of State • G8 - ”Health is the key to prosperity;" "poor health drives poverty”. Mobilization of resources for Global Fund in 2001. No commitment to chronic diseases. • G77 - no focus on chronic diseases but recent support for the FCTC. Critical of the draft Global Strategy on Diet, Health and Physical Activity Health Ministries • Inadequate capacity and budget for chronic diseases in most countries • WHO • NCD resolutions and global strategies agendas since 1956 • NCD cluster established at HQ in 1998 and capacity later developed at regions, but commitment not followed by funding Cambridge International Health Leadership Programme; April, 25th 2004

  42. Budgetary allocation and expenditure within WHO HQ to leading chronic and communicable diseases relative to DALYs attributed to leading chronic and communicable diseases, for the biennium 1/1/00 - 31/12/01 ONLY US$ 0.25 ALLOCATED TO LEADING CHRONIC DISEASES PER DEATH WITHIN WHO OPERATING BUDGET COMPARED WITH $14 FOR LEADING COMMUNICABLE DISEASES Cambridge International Health Leadership Programme; April, 25th 2004

  43. Policy of theAfrican Development Bank Group “The Bank does not currently have any specific policy or guidelines to address non-communicable diseases.” Source: Philibert Afrika, Director Operations Policies and Review, ADBG, personal communication, February 2003 Cambridge International Health Leadership Programme; April, 25th 2004

  44. Current status of key players (Continued) Business & investment community • Investment analysts warn that chronic disease risk factors are risky investments • Superficial CSR initiatives • Some new business markets emerging GlobalNGO's • NGO's focused support for chronic diseases not mobilised, although the Framework Convention Alliance supporting FCTC was effective Health and development initiatives • MDGs exclude chronic diseases • UNFPA does not include chronic diseases or risk factors in strategy on population and development • UNICEF's goal setting program, "A World Fit for Children," excludes reference to risk factors for chronic diseases amongst children. • World Summit of Sustainable Development does refer to chronic diseases Cambridge International Health Leadership Programme; April, 25th 2004

  45. Current status of key players (Continued) Media • Chronic diseases not perceived or reported as global health problems by broadcast or print news sources while acute infections are sensationalized Research journals • Pre-eminent medical journals do not publish content that accurately reflects global burden of disease Cambridge International Health Leadership Programme; April, 25th 2004

  46. New data on research output 1990-3 versus 2000-3 Cambridge International Health Leadership Programme; April, 25th 2004

  47. What's new about the rationale for action? • New epidemiological data: China as a pressing example • Focus on upstream macroeconomic determinants: chronic diseases spread by globalization (FDI focus), concentrated by urbanization • Synthesis of economic impacts: past studies and support of new initiatives • Links made with sustainable development • Assessment of WHO resolutions and funding • Review of stakeholder response to chronic diseases • New financial data on funding of chronic diseases • New data on research output on chronic diseases • …but none of this has to be inevitable Cambridge International Health Leadership Programme; April, 25th 2004

  48. Towards a new strategy for chronic diseases of lifestyle Vision • Better quality and years of healthy life • Reduce disparities Targets and objectives • Targets achievable at a stretch for prevalence by age, sex, class • Costed and budgeted New terminology • NCDs-can’t catch it, can’t communicate it • Chronic-lifelong, slow onset, serious • Lifestyle-chosen risks and behaviour Cambridge International Health Leadership Programme; April, 25th 2004

  49. Summary of changes for WHO From To • Sporadic advocacy • High level advocacy • Do it all alone • Work through and with partners • Sole impact on governments • Influence markets, governments & NGOs • Full range-from schools to neglect of higher order levers • Upstream health promotion • All diseases separately • Chronic care systems and effective secondary prevention • Rowing • Steering, leading Cambridge International Health Leadership Programme; April, 25th 2004

  50. New roles for key players Governments • Coherent chronic disease programmes & policies across all key sectors • advocacy: leadership, long-term view • Rules and incentives for healthier investment NGOs, consumer groups • Global networks of influence (Globalink for chronic diseases) • Local services: health promotion and care Investment/Pensions • Analysis of major trends and need for corporate change • Develop incentives for market changes Industry • New models beyond treatment must prioritize health • Changes in products , marketing and research Donors • Financial support that matches burden and preventive potential UN and related “family” • Placing chronic diseases on development agenda • Screen for chronic disease impacts access sectors Cambridge International Health Leadership Programme; April, 25th 2004

More Related