Burden of Noncommunicable Diseases: Global and National

Why Address NCDs?

Office of the WHO Representative in the Philippines

Noncommunicable Diseases (NCDs)

Heart diseases and strokes Cancers Diabetes Chronic respiratory diseases
Office of the WHO Representative in the Philippines

NCDs are a threat to everyone

NCDs are the number one killer in the world They claim over two-thirds of all deaths

That's 36 million people per year

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

25 % of all NCD deaths are premature (below 60 years) and could be prevented

Office of the WHO Representative in the Philippines

14.2 million people die every year from NCDs between the ages 30 and 69: Most of these premature deaths could have been prevented

Office of the WHO Representative in the Philippines

More than 85% of people who die from NCDs between the ages of 30 and 69 live in a developing country

Office of the WHO Representative in the Philippines

NCDs contribute to poverty and poverty increases the risk of developing NCDs

Office of the WHO Representative in the Philippines

It's economic effects are devastating.

The World Economic Forum ranks NCDs as one of the major global threats to economic development It's costing hundreds of billions of dollars every year in lost productivity
For every 10% rise in NCDs, annual economic growth falls 0.5%

Office of the WHO Representative in the Philippines

The cost of inaction in developing countries over the next 15 years is enormous (compared to the cost of action)

US$ 7T
is the cumulative lost output in developing countries associated with NCDs between 2011-2025

US$ 170B
is the overall cost for all developing countries to scale up action by implementing a set of "best buy" interventions between 2011 and 2025, identified as priority actions by WHO

Reports are available at www.who.int/ncd

Office of the WHO Representative in the Philippines

It has impact on attainment of MDGs

MDG1: Negative impact on productivity and family income MDG 2: Costs for NCDs health care, medicines, tobacco and alcohol consumption displace household resources for education MDGs 4 & 5:
Rising prevalence of high BP and gestational diabetes Mothers who smoke are likely to breastfeed for shorter periods of time and have lower quantities of milk and milk that is less nutritious

MDG 6: Diabetes associated with 10% of TB cases MDG 8: Affordable essential drugs in developing countries
Office of the WHO Representative in the Philippines

Four types of NCDs account for most deaths in most low-and middle-income countries

Office of the WHO Representative in the Philippines

Causation pathway for NCD

Office of the WHO Representative in the Philippines

There are Four Major Groups of NCDs Four major lifestyles related risk factors
Modifiable causative risk factors Harmful use of alcohol

Tobacco use

Unhealthy diets

Physical inactivity

Heart disease and stroke Noncommunicable diseases

Diabetes

Cancer

Chronic lung disease

Office of the WHO Representative in the Philippines

Changing times
Need social engineering

Office of the WHO Representative in the Philippines

Mortality Trend, Philippines, 1953-2005

Top Ten Cause of Mortality

Cause 1. Diseases of the heart 2. Diseases of the vascular system 3. Malignant Neoplasms 4. Accidents 5. Pneumonia 6. Tuberculosis 7. Unclassified 8. Chronic lower respiratory diseases Total 70, 861 51,680 40,524 34,483 32,098 26,770 21,278 18,975 Rate 84.8 61.8 48.9 41.3 38.4 31.0 25.5 22.7

9. Diabetes mellitus
10. Conditions originating from the perinatal period

16,552
13,180

19.8
15.8

Philippine Statistical Yearbook, 2009

Prevalence of hypertension, hyperglycemia, dyslipidemia & overweight 1998, 2003 and 2008
Risk factors
Hypertension Hyperglycemia Total cholesterol LDL-c HDL-c Triglycerides BMI (Overweight) 1998 21.0 3.9 4.0 8.1 76.6 8.7 20.2 2003 22.5 3.4 8.5 11.7 54.2 9.4 24.0 2008 25.3 4.8 10.2 11.8 64.1 14.6 26.6 Basis SBP 140, DBP 90 FBS > 126 mg/dL 240 mg/dL 160 mg/dL < 40 mg/dL 200 mg/dL BMI 25.0

Source: Philippine NNS, FNRI

Percent of the population with adequate PA, 2008

Total Male 23.8 20.3 27.4 22.7 26.0 22.1 19.9 Female 23.6 20.6 24.8 24.1 26.3 23.4 13.6

Philippines
20-29 30-39 40-49 50-59

23.7 20.4 26.5 23.2 26.1 22.6 17.5

60-60
70-up

Smoking
Prevalence of current smokers, 2008
Total Philippines 20-29 30-39 40-49 50-59 60-60 70-up 31 31.1 30.2 33 32.6 28.2 27.1 Male 53.2 57.7 53.2 55.5 54.6 45 32.9 Female 12.5 8.6 10.8 12.1 15.3 14.8 23.2

Alcohol
Prevalence of alcohol drinkers, 2008
Total Philippines 20-29 30-39 40-49 50-59 60-60 70-up 26.9 26.5 Male 47.5 47.2 Female 9.8 9.0

30.3
30.7 27.0 19.8 14.0

54.2
52.8 47.6 32.8 23.3

10.4
10.2 10.8 9.5 7.8

Regional Framework for Action

1 2
3

Advocacy

Research, Surveillance, Evaluation

Health Sector Response Whole of government response

Political will Political leadership Healthy public policies and laws

Health sector governance Health sector leadership Integration of NCD prevention and control into national health strategy

6
Health Systems Response
(Health Systems Strengthening)

Whole of society response

Community leadership Intersectoral partnerships Community mobilization

Health workforce development Health services organization/delivery Financing People-centred systems of care Focus on prevention

Office of the WHO Representative in the Philippines

WHO's global road map to prevent and control NCDs

2000
Global Strategy for the Prevention and Control of Noncommunicable Diseases

2003

Global Strategy on Diet, Physical Activity and Health Action Plan on the Global Strategy for the Prevention and Control of NCDs Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs

2004

2008

2009

2010

2011
Political Declaration on NCDs

2012+

Realizing Office the commitments made in in the Declaration of the WHO Representative thePolitical Philippines

Office of the WHO Representative in the Philippines

The Political Declaration on NCDs

Heads of State and Government and representatives committed to: Establish/strengthen, by 2013, national multisectoral policies and plans for NCDs, taking into account the Global Strategy for NCDs and its Action Plan Integrate NCDs policies and programmes into health-planning processes and the national development agenda of each Member State Develop national targets and indicators based on guidance provided by WHO and give greater priority to surveillance Accelerate implementation of the WHO FCTC, the Global Strategy on Diet, Physical Activity and Health, and the Global Strategy to Reduce the Harmful Use of Alcohol. Strengthen health systems that support primary care, prioritize early detection and treatment, and improve access to affordable essential medicines for NCDs

WHO Director-General

Rio+20: "NCDs constitute one of the major challenges for sustainable development"

We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and NCDs, and where populations can reach a state of physical, mental and social well-being. (paragraph 138)

We acknowledge that the global burden and threat of NCDs constitutes one of the major challenges for sustainable development in the twentyfirst century. (paragraph 141)

UN System Task Team on the post-2015 UN development agenda: NCDs is a priority for social development and investments in people

The MDGs did not adequately address increase in NCDs . (paragraph 19) Priorities for social development and investments in people would include: NCDs. Access to sufficient nutritious food and promotion of healthy life styles with universal access to preventive health services will be essential to reduce the high incidence of NCDs diseases in both developed and developing countries (paragraph 67)

Set of 9 voluntary global targets

Harmful use of alcohol 10% reduction
Premature mortality from NCDs 25% reduction

Essential NCD medicines and technologies 80%

Physical inactivity 10% reduction

Drug therapy and counseling 50%

Salt/ sodium intake 30% reduction Tobacco use 30% reduction Raised blood pressure 25% reduction

Diabetes/ obesity 0% change

Mortality and morbidity Risk factors for NCDs National systems response

Comprehensive Global Monitoring Framework

Mortality & Morbidity
Unconditional probability of dying between ages 30 and 70 years from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases

Risk Factors
Harmful use of Alcohol (3) Fruits and Vegetables Physical Inactivity (2)

National Systems Response

Cervical cancer Screening Drug therapy and counseling

Essential NCD Medicines

Salt
Hepatitis B Vaccine

Saturated Fat
HPV Vaccine

Tobacco use (2)

Marketing to children

Blood glucose/diabetes
Access to palliative care

Blood Pressure
Cancer incidence by type of cancer per 100 000 population

Overweight and Obesity (2) Total Cholesterol

Policies to limit SFA and virtual elimination of PHVO

NCD Best Buys

National Policy on Strengthening Prevention and Control of NCDs (2011)

Emphasized the need for strengthening health systems and whole-of-government, whole-ofsociety response to address the growing NCD problem in the Philippines.

Universal Health Care

Better health outcomes Responsive health system Equitable health financing

Financial Risk Protection

Achieving MDG max

Improving access to quality health facilities

Health Financing

Service Delivery

Policy, standards and regulation

Health Human Resource

Health Information

Governance for Health

Community health teams

Tobacco control legislation (2003)

The Tobacco Regulatory Act (RA 9211) of 2003 provided for the implementation of population-based tobacco control measures all over the country.

Sin tax legislation

.

Access to NCD medicines

The DOH Complete Treatment Pack (COMPACK) ensure access to essential drugs and medicines for the marginalized sector Includes medicines for hypertension, diabetes, hyperlipidemia, and asthma

Total Number of PhilHealth Claims for Hypertension, Diabetes, Cancer and Heart Disease from 2002-2012
250,000

200,000

150,000

100,000

50,000

0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Hypertension

Diabetes

Cancers

Heart Disease

Total Amount Paid for PhilHealth Claims for Hypertension, Diabetes, Cancer and Heart Disease from 2002-2012
4,000,000,000.00

3,500,000,000.00

3,000,000,000.00

2,500,000,000.00

2,000,000,000.00

1,500,000,000.00

1,000,000,000.00

500,000,000.00

0.00 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Hypertension

Diabetes

Cancers

Heart Disease

Expansion of Social Health Insurance Benefits for NCDs

Adoption of WHO Package of Essential NCD (PEN) Interventions

WHO-PEN implementation

Training, Implementation, Monitoring

 A nationwide healthy lifestyle movement that uses social media and aims to inform and encourage Filipinos from all walks of life to practice a healthy lifestyle by making a personal commitment to physical activity, proper nutrition, and the prevention or cessation of smoking and alcohol consumption.

CHALLENGES
Varying implementation of intervention across local government units Inadequate health financing for NCDs Inadequate allocation of funds for health promotion Inadequate multisectoral actions

Next steps
Continue and Monitor implementation
PEN/NCD services at primary health care Sin Tax and Tobacco Control legislations

Expand Philhealth benefits Intensify public health education campaigns Development of national multisectoral action plan for NCDs

Implementing low-cost workable solutions in developing countries could prevent most premature deaths from NCDs

2/3 + 1/3
Implementing cost-effective interventions that reduce exposure of populations to risk factors for NCDs will contribute up to two-thirds of the reduction in premature mortality. In addition, health systems that respond more effectively and equitably to the health-care needs of people with NCDs can reduce premature mortality by another one-third up to one-half.

Office of the WHO Representative in the Philippines

Mobilizing governments to include NCDs in health-planning processes and development initiatives needs to be one of your priorities

Office of the WHO Representative in the Philippines

Office of the WHO Representative in the Philippines

Thank you

Office of the WHO Representative in the Philippines