Reduction in Premature

Mortality from
NonCommunicable diseases.
Dr.Srinivas Ramaka.M.D.,D.M.
Consultant Cardiologist,
Srinivasa Heart Centre and
Chairman,Srinivasa Heart Foundation.Warangal.

What are NCDs?

What is the global status of NCDs?
25 by 25.
What are the global targets?
Key points.
Situation in India.
My work.

Noncommunicable diseases
Cardiovascular Diseases.
Cancers.
Chronic Respiratory diseases.
Diabetes.
Contribute to 82% of deaths due to NCDs.

Other NCDs: Renal, endocrine, neurological,

haematological, gastroenterological,hepatic,
musculoskeletal, skin and oral diseases and
genetic disorders.
Mental disorders;
Disabilities, including blindness and
deafness;and
Violence and injuries.

Global status of NCDs.

56 million deaths worldwide in 2012.
38 million (68%) due to NCDs.
16 million(40%) are premature<70 years of
age.
Three quarters of all NCD deaths (28
million), and the majority of premature
deaths (82%), occur in low- and middleincome countries.
WHO projects 52 million by 2030.

25 by 25.
The Moscow Declaration on NCDs - May
2011
The UN Political Declaration on NCDs
-September 2011
The World Health Assembly -May 2013
WHO Global Action Plan for the Prevention
and Control of NCDs 2013-2020
25% relative reduction in premature
mortality from NCDs by 2025(25 by 25).

9 global targets , 25 indicators

Global target 1: A 25% relative

reduction
in overall mortality from cardiovascular
diseases, cancer, diabetes or chronic
respiratory diseases.

Cardiovascular diseases-17.5 million deaths or

46.2% of NCD deaths. An estimated 7.4 million due to heart attacks (ischaemic heart disease)
and 6.7 million-- strokes.
Cancers-8.2 million, or 21.7% of NCD deaths),
Respiratory diseases, including asthma and
chronic obstructive pulmonary disease -4.0
million, or 10.7% of NCD deaths and
Diabetes -1.5 million or 4% of NCD deaths.
Four major NCDs were responsible for
82% of NCD deaths.

Global target 2: At least 10% relative

reduction in the harmful use of alcohol
as
appropriate, within the national
context.

Alcohol-disease burden.
3.3 million deaths, or 5.9% of all deaths
worldwide-2012,
More than half of these deaths resulted from
NCDs -chiefly cardiovascular diseases and
diabetes (33.4%), cancers(12.5%) and
gastrointestinal diseases, including liver
cirrhosis (16.2%).
5.1% of the global burden of disease as
measured in disability-adjusted lifeyears(DALYs) is attributed to alcohol
consumption.

Alcohol.
Implement cost-eff ective populationbased policy options
* taxation to regulate demand for alcoholic
beverages,
* restriction of availability of alcoholic
beverages,
*bans or restrictions on alcohol advertising
* Role of Health professionals in identifying
and treating alcohol dependance.

Global target 3: A 10% relative

reduction in the prevalence of
insufficient physical activity
Insufficient physical activity contributes to
3.2 million deaths and 69.3 million DALYs
each year.

Key points-physical activity

Regular physical activity at least 150
minutes of moderate intensity physical
activity per week for adults reduces the
risk of cardiovascular disease, diabetes,
cancer and all-cause mortality.
Children and young people aged 517
years should accumulate at least 60
minutes of physical activity of moderate to
vigorous intensity daily.

Globally, in 2010, 20% of adult men and

27% of adult women did not meet WHO
recommendations on physical activity for
health.
Amongst adolescents, aged 1117 years,
78% of boys and 84% of girls did not meet
these recommendations.
Strategies to improve physical activity
should be developed.

Global target 4: A 30% relative reduction in

the mean population intake of salt /sodium
Globally, 1.7 million annual deaths from
cardiovascular causes have been attributed to
excess sodium intake.
Current estimates suggest that the global mean
intake of salt is around 10 g daily (4 g/day of
sodium).
WHO recommends a reduction in salt intake to less
than 5 g/day (2 g/day of sodium), to reduce blood
pressure and the risk of coronary heart disease and
stroke.

Reducing salt intake- identified as one of the

most cost-effective measures for improving
population health.
Multisectoral collaboration is required to improve
access to products with lower sodium content.
The attainment of this target will contribute to
the attainment of the targets on reducing the
prevalence of raised blood pressure and, ultimately,
on reducing premature mortality from NCDs.

Global target 5: A 30% relative

reduction
in prevalence of current tobacco use in
persons aged 15+ years
It is estimated that currently around 6
million
people die annually from tobacco use, with
over 600 000 deaths due to exposure to
second-hand smoke.

Key points
Significant progress has been made in
implementing the most cost effective
tobacco-control measures but much still
remains to be done.
The WHO Framework Convention on
Tobacco Control provides the roadmap to
curb the tobacco epidemic.

Global target 6: A 25% relative reduction in

the prevalence of raised blood pressure, or
contain the prevalence of raised blood
pressure,according to national circumstances.
Prevalence-22% as in 2014.
9.4 million deaths and 7% of disease burden as
measured in DALYs in 2010.
The global prevalence of raised blood pressure
(defined as systolic and/or diastolic blood pressure
140/90 mmHg) in adults aged 18years and over
was around 22% in 2014.

Implementation of population-wide policies

to reduce behavioural risk factors,including
harmful use of alcohol, physical inactivity,
overweight,obesity and high salt intake, is
essential to attaining this target.
Control of hypertension through a total
cardiovascular risk approach is more cost
effective than treatment decisions based on
individual risk factor thresholds only.

Global target 7: Halt the rise

in diabetes and obesity.

Worldwide, obesity has more than doubled since

1980,
In 2014, 11% of men and 15% of women aged 18
years and older were obese.
42 million children under the age of 5 years
were overweight in 2013.
The global prevalence of diabetes- 9% in 2014.
Obesity can be prevented through multisectoral
population-based interventions that promote
physical activity and consumption of a healthy
diet, throughout the life-course.

Global target 8: At least 50% of eligible

people receive drug therapy and
counselling (including glycaemic
control)
to prevent heart attacks and strokes

Cost-effective interventions,for early

detection and treatment. in primary care and
in resource-constrained settings, is needed.
Achieving this target requires strengthening of
the key components of the health system
including sustainable healthcare financing, to
ensure access to basic health technologies and
essential NCD medicines.
The attainment of this target will contribute
to attainment of the target on reducing
premature mortality from NCDs.

Global target 9: An 80% availability

of the affordable basic technologies
and essential medicines, including
generics, required to treat major
noncommunicable diseases in both
public and private facilities.

Currently, there are major gaps in the

affordability and availability of basic health
technologies and essential medicines,
particularly in low- and middle-income
countries.
The lack of access means that patients
delay seeking care and either develop
complications unnecessarily or pay high
out-of-pocket costs, which can financially
devastate households.

HEALTH TECHNOLOGIES.

National health strategy should include access to

health technologies and essential medicines as
an objective .
Should specify a mechanism for monitoring,
evaluation and review of the availability and
affordability of basic health technologies and NCD
medicines.
Achieving this target requires sustainable
health-care financing,to ensure adequate
procurement of basic health technologies and
essential NCD medicines.

Country efforts to improve access should first

focus on basic health technologies and
essential medicines for NCDs, and the national
essential medicines list should be the basis for
procurement, reimbursement and training of
health-care workers.
Reliable procurement and distribution
systems are needed to guarantee the supply of
essential NCD medicines and technologies to
all levels of health care, including primary care,
and to regional and remote communities.

Quality-assured generic medicines are procured;

prescribers and consumers need to have confi ence in the
generic medicines in circulation.
Evidence-based treatment guidelines and protocols
should be promoted and implemented, to support the
appropriate use of essential NCD medicines.
Th e attainment of this target will contribute to
attainment of targets on reducing the prevalence of
hypertension, on improving coverage of treatment for
prevention of heart attacks and strokes and, ultimately, on
reducing premature mortality from NCDs.

Monitoring premature mortality from

noncommunicable diseases.
The premature mortality target is, a 25%
reduction in overall mortality from cardiovascular
diseases,cancer, diabetes or chronic respiratory
diseases by 2025 (referred to as 2525).
The probability of dying between the ages of 30
and 70 years from these four diseases, is the
indicator in the global monitoring framework that
monitors progress in attaining this target by
2025.

Key points and need of the hour

1.NCDs act as key barriers to poverty alleviation
and sustainable development .
High-level commitment,establish/strengthen the NCD
unit in the ministry of health, NCDs are accorded due
consideration in national strategic health planning.

2.Some countries making progress, but majority

are off course to meet the global NCD targetsdevelop national plan.
3.Countries need to act by prioritizing highimpact,
affordable interventions.
4.Need to set national NCD targets.

5.Establish Structures and processes for

multisectoral and intersectoral collaboration .
6.Investment in health systems is critical for
improving NCD outcomes.
7 Institutional and human resource capacities
and fi nancial resources for NCD prevention
and control require strengthening at all levels.
Health promotion/prevention and curative,
rehabilitative and palliative care, to achieve
universal health coverage.

STATUS IN INDIA

NCDs-42% of all deaths.

Prevalence of DM,HTN,IHD and Stroke is 62.47,
159.46, 37.00 and 1.54 respectively per 1000 of
India.
Prevalence of current tobacco use was 570 %
among men and 10.8% among women.
The cancer registry data reveals that 48% of
cancers in males and 20% in females are
tobacco related and are totally avoidable.
The probability of dying between ages 30
and 70 years from the 4 main NCDs is 26%.

ADULT RISK
FACTORS
Current Tobacco
smoking
(2011)
Total alcohol per
capita
consumption,in litres
of
Pure alcohol
Raised blood
pressure
(2008)
Obesity (2008)

MALES
25%

FEMALES
4%

TOTAL
15%

8%

0.5%

4.3%

21.3%

21%

21.1%

1.3%

2.4%

1.9%

National systems response to

NCDs

Operational NCD unit/branch or department within

the Ministry of Health, or equivalent Yes
Operational multisectoral national policy, strategy
or action plan that integrates several NCDs and
shared risk factors No.
Operational policy, strategy or action plan to
reduce the harmful use of alcohol Yes.
Operational policy, strategy or action plan to
reduce physical inactivity and/or promote physical
activity Yes.
Operational policy, strategy or action plan to
reduce the burden of tobacco use Yes.

Operational policy, strategy or action plan to

reduce unhealthy diet and/or promote healthy
diets Yes.
Has evidence-based national
guidelines/protocols/standards for the
management of major NCDs through a
primary care approach No.
Has an NCD surveillance and monitoring system
in place to enable reporting against the nine
global NCD targets- No.
Has a national, population-based cancer
registry No.

National Rural Health Mission ASHAAccredited Social Health Activist.

TIP OF THE ICEBERG CONCEPT

3 As.
Awareness.
Access.
Affordable.
COMMUNITY PROGRAMS.
KNOW YOUR HEART PROGRAM.
TOBACCO PREVENTION.
CPR TRAINING.
HEART PROGRAM
RESEARCH-CADY STUDY,STUDY OF OOHCA.

We must become the change we want to

see---Mahatma Gandhi.