Non communicable Diseases - PDF Free Download

Non communicable Diseases Vision, Goals and Challenges Where we are in Palestine? Dr. Johny R. Khoury Consultant Cardiologist Medical Relief Prevention and Diagnostic Center of cardiovascular diseases / Ramallah The 2 nd international conference of cardiac society / Bethlehem June 2012

Environmental factors that reduce physical activity and promote overeating

Non-communicable diseases (NCD`s) Globally: leading killer today with enormous challenge in the future Eastern Mediterranean Region : > 50% of annual deaths ( 2005) > 60% of disease burden Plan of action for the prevention and control of NCD`s in the Eastern Mediterranean Region 2011 WHO

What are the major Non-Communicable diseases? Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Heart disease and stroke Diabetes Cancer Chronic lung disease

The NCD`s Epidemic Ageing Urbanization Globalization

Proportion of global NCD deaths under the age of 70, by cause of death, 2008 WHO 4% 30% 27% 39%

Non communicable Diseases

may be the tip of the Iceberg for a hidden catastrophe of the 21st century

CVD`s : major health challenge of the 21st century Billions Of the estimated 57 million global deaths in 2008, 63% were due to (NCDs) projection of the annual number of deaths + 60% 17 mill. 25 mill. 2008 2030 WHO Global status report on NCD`s / 2010

CVD`s : major health challenge of the 21st century Billions Of the estimated 57 million global deaths in 2008, 63% were due to (NCDs) + 60% 17 mill. 25 mill. 2008 2030 WHO Global status report on NCD`s / 2010

Facts The rapidly increasing burden is in developing countries 80 % of NCD deaths occur in low- and middleincome countries EMR, SEAR & AFR 29% among people < age of 60, compared to 13% in high income countries WHO Global status report on non communicable diseases (NCDs) 2010

Facts The rapidly increasing burden is in developing countries 80 % of NCD deaths occur in low- and middleincome countries EMR, SEAR &AFR 29% among people < age of 60, compared to 13% in high income countries NCD epidemic is projected to kill 52 million people annually by 2030 WHO Global status report on non communicable diseases (NCDs) 2010

WHO projections NCD deaths globally Between 2010 and 2020 there will be an increase of >17%

WHO projections NCD deaths highest increase Eastern Mediterranean (25%) South-East Asia Africa (27%)

5.11 18.8

Top 10 : Countries / Territories of number of people with DM (20 79 years), 2011 and 2030 Country 2011 millions Country 2030 millions 1- China 90 2- India 61.3 3- USA 23.7 4- Russian Federation 12.6 5- Brazil 12.4 6- Japan 10.7 7- Mexiko 10.3 8- Bangladesh 8.4 9- Egypt 7.3 10- Indonesia 7.3 1- China 129.7 2- India 101.6 3- USA 29.6 4- Brazil 19.6 5- Bangladesh 16.8 6- Mexico 16.4 7- Russian Federation 14.1 8- Egypt 12.4 9- Indonesia 11.8 10- Pakistan 11.4

Economic Burden of NCDs, 2011-2025 (trillions of US$ in 2008) economic losses who Country income group Diabetes Cardiovasc ular diseases Respiratory diseases Cancer Total Upper middle 0.31 2.52 1.09 1.20 5.12 Lower middle 0.09 1.07 0.44 0.26 1.85 Low income 0.02 0.17 0.06 0.05 0.31 Total of low and middle 0.42 3.76 1.59 1.51 7.28

Projections of Crude CV Disease Prevalence (%) (AHA 2011) The prevalence of CardioVacular Disease 2030 The Heart.Org. Cost of cardiovascular disease to triple by 2030. Published online 25 January, 2011. Year All cardiovascu lar disease Hypertensi on Coronary heart disease Heart failure Stroke 2010 36.9 33.9 8.0 2.8 3.2 2015 37.8 34.8 8.3 3.0 3.4 2020 38.7 35.7 8.6 3.1 3.6 2025 39.7 36.5 8.9 3.3 3.8 2030 40.5 37.3 9.3 3.5 4.0 % change 9.9 9.9 16.6 25.0 24.9 9.9

AHA 2011 : Cost of cardiovascular disease to triple by 2030 Projected direct medical costs of CVD ($ B) The Heart.Org. Cost of cardiovascular disease to triple by 2030. Published online 25 January, 2011 Year All cardiovascul ar disease Hypertension Coronary heart disease Heart failure Stroke 2010 272.5 69.9 35.7 24.7 28.3 2015 358.0 91.4 46.8 32.4 38.0 2020 470.3 119.1 61.4 42.9 51.3 2025 621.6 155.0 81.1 57.5 70.0 2030 818.1 106.4 77.7 95.6 200.3 % change 200 186 198 215 238

Non-Communicable Diseases in Palestine Where we are going?

Palestine Prevalence of risk factors based survey representative sample (5470) adults aged 25-64 y/o 2011) Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO

Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO Prevalence of tobacco smoking The highest prevalence 29% in the European Region, the lowest in the African Region (8%). EM region Tobacco consumption, prevalence of smoking among adult men ranges between 12% and 60% In Palestine, percentage who currently smoke tobacco daily: 23.2% Male Female 43.2% 3.1%

Percentage with insufficient physical activity (2008 estimates) 50% Worldwide about 30% over 15 years have insufficient physical activity 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Men Women Both Sexes Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO

Prevalence of low physical activity in selected Arab Countries Palestine 49.9% Males 38.3% Females 61.6% Region according to the STEPwise survey done by WHO 2003 2007.

Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO 70% 60% 50% Prevalence of overweight in adults (2008 estimates) Worldwide 35% of adults are overweight Palestine 71.9% Males 68.1% Females 76.1% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Men Women Both Sexes

Prevalence of Obesity in some Arab countries 4 2 3 1 Country Male % Female % 1- Kuwait 30 55 5 2- Egypt 22 48 3- Lebanon 15 27 4- Tunisia 8 33 WHO estimates for 2011 5- Sudan 2 7

Prevalence of Obesity in some Arab countries 4 2 3 1 Country Male % Female % 1- Kuwait 30 55 5 2- Egypt 22 48 3- Lebanon 15 27 4- Tunisia 8 33 WHO estimates for 2011 5- Sudan 2 7 Palestine 36.6 % Male: 30.6% Female: 43.3%

Obesity in children aged 2-19 in various Arab countries Arab country Age Male Female Bahrain 12 17 15% 18% UAE 5 17 13% 13% Kuwait 5 13 9% 11% Lebanon 3 19 8% 3% Tunisia 11 19 6% 10% Egypt 11 19 6% 8% WHO estimates for 2011

Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO Prevalence of diabetes (2008 estimates) 15% The global prevalence was estimated to be 10% in adults aged 25 years. 10% 5% 0% AFR AMR EMR EUR SEAR WPR Men Women Both Sexes

Prevalence of diabetes in the Eastern Mediterranean Region WHO

Prevalence of diabetes in the Eastern Mediterranean Region WHO Palestine 12.5% Males 14% Females 11%

Prevalence of raised blood pressure (2008 estimates) 50% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Lowincome Lowermiddleincome Upper- Middle- income- Highincome Men Women Both Sexes Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO

Prevalence of raised blood pressure (2008 estimates) 50% Palestine 45.3%, Males 44.8%, Females 45.7% Palestine 45.3%, Males 44.8%, Females 45.7% 40% 30% 20% 10% 0% AFR AMR EMR EUR SEAR WPR Lowincome Lowermiddleincome Upper- Middle- income- Highincome Men Women Both Sexes Results of the STEPS survey in opt, 2010 2011,1 st NCD conference April 2012 Ramallah, Dr. Shanti / WHO

Medical Relief Prevention and Diagnostic Center of Cardiovascular Diseases /Ramallah Results obtained out of the data of the screening of 10590 persons in the period between 2000 and 2004

Medical Relief Chronic Disease Center Risk Factors Prevalence% Overweight (BMI > 25 and < 30) 71 Obesity (BMI> 30) 43 Hypertension ( BP 140/90 mmhg or 31 use of anti-htn medication) Diabetes Mellitus (FBS > 126 mg/dl) 12 Evaluation Report /2004 IFG Glucose level (FBS 111 to 125 mg/dl ) 6 Dyslipidemia (TC>200 and/or 43 TG>200 and/or HDL<40 mg/dl)

NCDs are going on the rise in Palestine Behavioral Risk factors Metabolic / physiological risk factors Tobacco use Unhealthy diet Physical inactivity Raised blood pressure Overweight / Obesity Raised blood glucose Raised lipids NCD Underlying drivers Social Determinants of Health ageing Globalization Urbanization Population

The Key solution CVD Risk Factors Metabolic Syndrome

Best Buys Feasible, affordable and high impact WHO

Still water run deep

Conclusions Ageing, Urbanization & Globalization, accelerate toward reduced fitness levels and rising obesity rates NCDs are a real danger to public health and economic development in present and in the future The situation is likely to be worsen with more serious economic consequences especially in the LMIC

.. NCDs are the leading cause of death among adult population in the Palestinian society. Diabetes, cancers, and CVD including hypertension and stroke contribute to more than 50% of causes of death among adults

Conclusion : Prevalence of NCDs in Palestine PMRS 2004 % MoH /WHO 2011 % Overweight 71 71.9 Obesity 43 36.6% Hypertension 31 25.5 (no medication) 45.3 (on medication) Diabetes 12 (+6% IFG) 12.5 Dyslipidemia 49 ########## Hypercholestrolemia ############# ## 47.4

"We are learning what Hippocrates taught, two and a half thousand years ago, that it is more important to prevent the patient s illness than to cure him. There are better things to do with life than recover. Hippocrates - the father of medicine (440-340 B.C.)