Meeting the chronic disease challenge: high level regional workshop Dr. Kenneth Thorpe Jakarta, Indonesia 1
ABOUT THE PFCD The PFCD believes that rising rates of chronic health problems pose a significant and unsustainable burden on national health care systems, and that the viability and strengths of those systems presently and in the future relies on a willingness to enact policies that help people better prevent and manage chronic illnesses. OUR MISSION EDUCATE the public about chronic disease and potential solutions for individuals and communities MOBILIZE the public to call for change in how governments, employers, and health institutions approach chronic disease CHALLENGE policymakers on the health policy changes that are necessary to effectively @ight chronic disease 2
WHO SOUTH EAST ASIA REGIONAL MEETING MARCH 2011 Jakarta Call for Action on Noncommunicable Diseases noted that : Noncommunicable diseases are now the leading cause of death in the WHO South East Asia region member states & account for 54 percent of all deaths. Deaths from non communicable diseases are projected to increase by 21 percent over the next 10 years. In the South East Asia Region the death rates in middle aged adults is disproportionately higher than in high income countries. NCDs have a substantial economic impact as reducing the Gross Domestic Product by an estimated1 5 per cent in low and middle income countries. The epidemic of NCDs exacerbates poverty, is a barrier to societal and economic development and could reverse hard won development gains. 3
CAUSATION PATHWAY FOR CHRONIC NONCOMMUNICABLE DISEASES Source: A. Dans, et.al., The rise of chronic non-communicable diseases in southeast Asia: time for action, The Lancet, 2011, 337:681. 4
PREVALENCE NCD RISK FACTORS & BEHAVIORS: INDONESIA Risk Factor/Behavior Male Female Total Daily Tobacco Smoking 53.4 3.4 28.2 Insufficient Physical AcFvity 31.9 27.9 29.9 Raised Blood Pressure 38.9 36.0 37.4 Raised Blood Glucose (FasFng>7.0mmol or on meds) 6.0 6.5 6.3 Overweight (BMI>25) 16,3 25.6 21.0 Raised Total Cholesterol 32.8 37,2 35.1 Source: WHO Global Status Report on Noncommunicable Diseases 2010 5
ESTIMATES OF DEATHS FROM NCDs ASEAN COUNTRIES 2008 In 2008 nearly 2.7 million people in ASEAN countries died from 4 chronic non communicable diseases: Cancers, Chronic Respiratory Diseases, Cardiovascular Diseases & Diabetes ASEAN Country Total NCD Deaths NCD Deaths Under Age 70 Indonesia 1,064,000 563,700 Thailand 418,400 198,100 Philippines 309,600 191,800 Malaysia 89,500 46,325 Viet Nam 430,000 160,700 Myanmar 242,400 115,000 Singapore 17,900 8,000 Cambodia 56,600 38,400 Laos 23,800 13,500 Brunei Darussalam 10,000 5,300 Source: WHO Global Status Report on Non-communicable diseases 2010 6
PREVALENCE ESTIMATES FOR DIABETES IN ASEAN COUNTRIES 2010 & 2030 If current trends continue The number of people in ASEAN countries with diabetes will grow from 19.2 to 33.3 million over the next 20 years ASEAN Country 2010 2025 Indonesia 6,943,500 11,980,000 Thailand 3,538,000 4,956,200 Philippines 3,398,200 6,163,800 Malaysia 1,846,000 3,244,500 Viet Nam 1,646,600 3,414,900 Myanmar 921,800 1,754,900 Singapore 436,600 742,000 Cambodia 354,000 724,200 Laos 143,300 301,500 Brunei Darussalam 28,200 46,600 Source: International Diabetes Federation, World Diabetes Atlas Fourth Edition 2010 7
POVERTY CONTRIBUTES TO NCDs & NCDs CONTRIBUTE TO POVERTY Source: A. Dans, et.al., The rise of chronic non-communicable diseases in southeast Asia: time for action, The Lancet, 2011, 337:681. 8
RELATIONSHIP BETWEEN POVERTY & NCDs In some countries, the lowest income households have the highest levels of NCD risk factors. WHO Global status report on NCDs 2010 Source: A. Dans, et.al., The rise of chronic non-communicable diseases in southeast Asia: time for action, The Lancet, 2011, 337:681. 9
WHO GLOBAL STATUS REPORT ON NCDs NCDs are the biggest global killers. Sixty-three percent of all deaths in 2008, 36 million people, were from NCDs. Nearly 80% of NCD deaths are in low and middle-income countries, where the highest proportion of NCD deaths under age 70 occur. The prevalence of NCDs, and the number of related deaths, are expected to increase substantially in the future, particularly in low- and middle-income countries, due to population growth and ageing, in conjunction with economic transition and resulting changes in behavioral, occupational and environmental risk factors. NCDs already disproportionately affect low- and middle-income countries. Projections indicate that by 2020 the largest increases in NCD mortality will occur in low- and middle-income countries. 10
THE FIGHT AGAINST CHRONIC DISEASE The United States cannot effec1vely address escala1ng health care costs without addressing the problem of chronic diseases. The CDC Chronic diseases are the leading causes of death and disability in the United States and account for the vast majority of health care spending. They affect the quality of life for 133 million Americans and is responsible for seven out of every ten deaths in the U.S. killing more than 1.7 million Americans every year. Chronic diseases account for more than 75 cents of every dollar we spend on health care in this country. In 2007, this amounted to $1.65 trillion of the $2.2 trillion spent on health care. 11
PROVEN INTERVENTIONS Personalized acfon plans Responsibility and accountability for outcomes Team based, coordinated care that supports selfmanagement IntegraFng with communitybased resources Regular monitoring and follow up 12
FILLING COSTLY GAPS Fee for service (FFS) System Gaps in con@nuum of care High rate of readmission within 30 days Disconnect among pa@ents receiving Medicaid and Medicare 13
ENHANCING ADHERENCE One in four Americans do not follow direc@ons in taking medica@ons 3 out of 4 Americans admit to having not taken their medicines as prescribed at some point Nearly two thirds of all medica@on related hospital admissions have been aoributed to poor adherence Poor medica@on adherence costs more than $100 billion a year na@onwide 14
PROMOTING COORDINATED CARE The Affordable Care Act can offer financial assistance to create and foster beoer care coordina@on. Integrated medical prac@ces Medical home models Growth in Accountable Care Organiza@ons Medicaid health plan models Community Health Teams 15
TURNING THE TIDE The smoking rate of Medicaid recipients is approximately 53 percent higher than in the general US populafon Smoking adributable costs to the states under Medicaid were $22 billion in 2004 Medicaid also has a much higher prevalence of obesity than other health insurance providers and pays more for inpafent and outpafent services and medicafon for obese pafents Improving overall health is the best way to improve our health care costs. 16
CAPITALIZING ON OPPORTUNITY THE TIME IS NOW! Advance policy changes that address chronic disease Work to reorient care systems to focus on prevenfon 17
JAKARTA CALL FOR ACTION ON NCDs MARCH 2011 Calls upon governments & parliaments to: Accord a high priority to prevention & control of NCDs in national health policies & programs and accordingly increase overall budgetary allocations for NCDs. Scale up national plans for action & implement the WHO Framework Convention on Tobacco Control and advance health promotion, primary prevention and develop regulations on alcohol & processed foods. Fund and strengthen primary health care preventive, promotive and curative care interventions to ensure access of the poor and vulnerable. Develop surveillance programs to monitor & evaluate the impact of interventions & support research into the prevention & control of NCDs Build capacity of the health workforce, including community based health workers for prevention and control of NCDs. 18