Why Non communicable Diseases? Why now? Professor Michelle A. Williams Chair, Department of Epidemiology Harvard School of Public Health November 8, 2012 Addis Ababa, Ethiopia
Non communicable Diseases (NCDs) NCDs include CVDs, diabetes, cancer and chronic respiratory disease and mental health Account for 60% of all deaths globally, 80% are in low and middle income countries Contrary to common perception, the burden of NCDs is worst in low & middle income countries In sub Saharan Africa, NCDs are projected to surpass infectious diseases by 2030
Non communicable Diseases (NCDs) Prevalence of many of known risk factors for NCDs has dramatically increased in developing countries societal and environmental changes NCDs have serious implications for economic development and growth Affordable solutions exist to prevent 40 to 50% of premature deaths from NCDs 14 million lives per year in developing countries
Deaths attributed to 19 leading factors,by country, WHO 2004
Percentage of disability adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, WHO 2004 A DALY is a healthy life year lost
Top leading risk factor causes of death in high income coutries, 2004 Risk factor Tobacco use High blood pressure Overweight and obesity Physical inactivity High blood glucose High cholesterol Low fruit and vegetable intake Urban outdoor air pollution Alcohol use Occuopational risks 2.5 2.5 1.6 1.1 5.8 7 7.7 8.4 Percentage of total 16.8 17.9 0 2 4 6 8 10 12 14 16 18 20
Projected deaths by cause and income (2004 to 2030) 30 25 WHO Estimates Intentional injuries Other unintentional Road traffic accidents Deaths (millions) 20 15 10 Other NCD Cancers CVD 5 0 2004 2015 2030 2004 2015 2030 2004 2015 2030 High income Middle income Low income Mat//peri/nutritional Other infectious HIV, TB, malaria
Age-standardized deaths due to cardiovascular disease (rate per 100,000) in 2004
Hypertension Prevalence Globally in people aged 20 years and older 2000 Kearney et al, 2005
Hypertension Prevalence Globally in people aged 20 years and older 2025 Kearney et al, 2005
Diabetes Atlas - Country Estimates 2011 Country/territory Adult Population (20 79) in millions Diabetes cases (20 79) in millions Diabetes national prevalence (%) China 968.9 90.0 9.29 India 737.3 61.2 8.31 United States of America 216.8 23.7 10.94 Russian Federation 109.2 12.6 11.54 Brazil 127.9 12.4 9.72 Japan 95.3 10.7 11.20 Mexico 69.3 10.3 14.85 Bangladesh 87.7 8.4 9.58 Egypt 48.3 7.3 15.16 Indonesia 154.3 7.3 4.73 Ethiopia 39.9 1.3 3.45
Diabetes Atlas - Country Estimates 2030 Adult Population (20 79) in millions Diabetes cases (20 79) in millions Diabetes national prevalence (%) Country/territory China 1,072.3 129.7 12.10 India 1,017.5 50.6 9.95 United States of America 250.5 29.6 11.82 Brazil 159.6 19.6 12.28 Bangladesh 126.9 16.8 13.27 Mexico 93.3 16.4 17.63 Russian Federation 101.5 14.1 13.90 Egypt 69.5 12.4 17.81 Indonesia 198.5 11.8 5.95 Pakistan 146.8 11.4 7.77 Ethiopia 70.1 2.6 3.75
WHO: Commission on Macroeconomics and Health Ill health undermines economic development and efforts to reduce poverty. Investments in people s health are vital pre conditions for economic growth and human development.
Economic Burden of NCDs, 2011-2025 (trillions of US$ in 2008) Country income group Diabetes Cardiovascular 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 Lowe 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
The UN Millennium Development Goals and Non Communicable Diseases (NCDs)
The UN Millennium Development Goals and Non Communicable Diseases (NCDs) MDGs state that health is critical to the economic, political and social development of all countries NCDs are a major cause of poverty, a barrier to economic development, and a neglected global emergency
What is happening in Ethiopia?
Population Pyramid, 2011, Ethiopia ~80 86 million Data from EDHS 2011
Projections ETHIOPIA 2020 2030 source: populationpyramid.net
Proportional Mortality NCDs are estimated to account for 34% of all deaths WHO NCD Country Profiles, 2011
Urbanization Urban population~ 18% of total population (2010) Rate of urbanization: 4.3% per annum Capital Addis Ababa 2010: ~ 3.6 million 2015: Projected 5.1 million > 97.7% urban and the rest in peri urban fringes Regional cities are also growing fast CIA World Factbook and UNEP
A It is not all bad news there are prevention and control strategies that can work
Specific Prevention & Control Strategies 1. Raise the priority to NCDs in development work at global and national levels, and integrate prevention & control of NCDs into policies across all government departments 2. Establish and strengthen national policies and plans for the prevention and control of NCDS 3. To promote interventions to reduce the main shared modifiable risk factors for NCDs WHO Global Strategy, 2008-2013 Action Plan
Specific Prevention & Control Strategies 4. Promote research for the prevention and control of NCDs 5. Monitor NCDs and their determinants and evaluate progress at the national, regional and global levels 6. Promote partnerships for the prevention and control of NCDs WHO Global Strategy, 2008-2013 Action Plan
WHO Best Buy Interventions Risk factor/ disease Tobacco use Harmful alcohol use Unhealthy diet and physical inactivity Cardiovascular disease (CVD) and diabetes Interventions Tax increases Smoke free indoor workplaces and public places Health information and warnings Bans on tobacco advertising, promotion & sponsorship Tax increases Restricted access to retailed alcohol Bans on alcohol advertising Reduced salt intake in food Replacement of trans fat with polyunsaturated fat Public awareness through mass media on diet and PA Counseling and multi drug therapy for people with a high risk of developing heart attacks and strokes (including those with established CVD) Treatment of heart attacks with aspirin
THANK YOU! Knowing is not enough; we must apply. Being willing is not enough; we must do. Goethe