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1. 1
2. 2 Chronic non-communicable disease Prof. Sulaiman Al-Shammari
Department of Family & Community Medicine , College of Medicine King Saud University , Riyadh, Saudi Arabia
3. 3 The chronic non-communicable disease
4. 4 Deaths by broad cause group
5. 5
6. 6
7. 7
8. 8 EPIDEMIOLOGICAL PECULIARITIES 1. Multifactorial Causation
2. Latent Period
3. Insidious onset
4. Non-reversible changes
5. Modification In life-style
6. Multi-directional Approach
9. 9 Obesity Is a type of malnutrition that is characterized by abnormal growth of adipose tissue.
This can occur due to increase in size and! or number of the fat cells.
BMI > 30 in males and 28.6 in females is indicative of obesity.
10. 10 Over weight Is the term used for weight more than expected for given age, sex, and occupation.
11. 11 Aetiology OF Obesity 1. Age: increases with the age. Overweight infants are more likely to be obese adults,
2. Sex: Post-menopausal women are more likely to gain weight. In men, obesity occurs a decade earlier than females.
3. Sedentary Life Style:
4. Genetic Factors:
5. Diet:
6. Psychosocial Factors:
7. Endocrine Factors:
12. 12 Measurement of Obesity 1: 1. Body Weight: The actual body weight (ABW) is compared with the expected body weight. (EBW) Following methods are commonly used to calculate the expected weight. + Broca’s Method: EBW = Height in cm — 100 + Lorenze’s Method: EBW (males) = Ht in cm — 100 — {(Ht in cm- 150) I 4} EBW (females) = Ht in cm — 100 — {(ht in cm- 150) I 2} The ratio ABWI EBW is called Corpulence Index. If it is more than 1.2 it is considered over-weight.
13. 13 Measurement of Obesity 2: 2. Body Mass Index (BMI): BMI = W I H Here W = weight in Kg, and H = Height in meters. The desirable range of BMI is:
Males: 20.1- 25
Females: 18.7—23.8
A person is considered obese if BMI is above 30.0 in males, and 28.6 in females.
14. 14 Measurement of Obesity 3: 3. Skin Fold Thickness: Measurement of skin fold thickness at mid-triceps, biceps, sub-scapular region, and supra-iliac regions are used for this purpose. However, this method is not popular due to lack of standardization, poor repeatability, and technical problems involved in the measurement.
15. 15 Hazards of Obesity: Mortality: Obesity is a known risk factor for mortality in IHD, hypertension, and renal diseases. Morbidity: Obesity is a risk factor for a number of conditions like hypertension, lHD, gallstones, and osteo-arthritis.
In addition, obese persons carry higher risk of post-operative complications and accidents.
16. 16 Prevention and Control: 1. Diet: Reduction in fats and carbohydrates in the diet, (especially refined foods, sweets, oils etc) is recommended both for treatment as well as prevention. Increase in consumption of dietary fibers is un-refined foods the other side of the coin.
2. Physical Exercise: Regular physical exercise
like fast walking, playing out-door games like tennis, and swimming are necessary adjuvant to diet.
3. Other Measures: These include use of drugs, removal of excess fat by surgery, gastric bypass etc are tried, but have limited value.
17. 17 Coronary Heart Diseases (CHD Ischaemic Heart Diseases (IHDS) Coronary heart diseases is considered the world’s modern (epidemic) as stated by WHO.
18. 18 Definition OF CHD : It can be defined as the impairment of the heart function due to inadequate blood flow to the heart, compared to its needs, caused by obstructive changes in the coronary circulation to the heart.
19. 19 CHD may manifest itself in many presentations: a) Angina pectoris on effort. b) Myocardial infarction. c) Heart irregular rhythms. d) Cardiac failure. e) Sudden death.
20. 20 Magnitude and burden of CHD: cause of 1/4 deaths in industrialized countries.
first leading cause of death in these countries. -
25 to 28% heart attacks die suddenly instantly or within 24 hours
55% of all cardiac deaths, mortality occurs within the first hours.
CHD. death in developing countries lower than developed,
Masked by other causes
Problems in diagnosis and reporting also play a role.
However, CHD death rates in those countries are increasing; eg
Singapore, death rate doubled ,within 20 years
21. 21 Epidemiology1 Person: more among the middle- aged and older men.
due to accumulation of hazards.
men have more CHD death rates than women
more among CHD family histories
hypertension and diabetes mellitus prone CHD
life styles and habits
type A personalities more prone to CHD.
high social class in the 1950’s; however, since the 1970’s it became more among lower classes.
22. 22 Epidemiology2 Tme: - Epidemics began at different times in different countries.
In USA in the early 1920’ s,
in Britain in 1930’s & later in European countries.
Now, the developing countries are catching up,
Epidemics started earlier, are now showing a decline.
USA, decline seen 1968, with a 25% fall in mortality
by 1980. Declines in NZ, Canada and Australia.
23. 23 Epidemiology 3 Place:
Highest mortality in North Europe
South Europe are much lower
Japan are extremely low
Developing countries, CHD death rates are increasing.
24. 24 Aetiology and risk factors CHD: Multifactorial.
The greater the factors present the more CHD.
Non- modifiable factors (i.e. risk markers): age, sex (male), FH, genetic and personality
Modifiable factors (i.e. risk factors):smoking, hypertension, cholesterol , diabetes , obesity, sedentary habits and stress).
25. 25 1. Smoking: Major CHD risk factor.
responsible for 25% deaths under 65 men.
The risk is directly related to No/day
Synergistic with other risk factors
26. 26 2. Hypertension: Accelerates the atherosclerotic process, especially if hyperlipidaemia present
SBP better predictor CHD than DBP.
However, both are important risk factors.
27. 27 3. Serum cholesterol: Population with CHD have high choesterol
Cholesterol important risk factor for CHD
LDLmost directly related to CHD.
28. 28 ATP III Lipid and Lipoprotein Classification LDL Cholesterol (mg/dL)
<100 Optimal
100–129 Near optimal/above optimal
130–159 Borderline high
160–189 High
?190 Very high
29. 29 ATP III Lipid and Lipoprotein Classification (continued) HDL Cholesterol (mg/dL)
<40 Low
?60 High
30. 30 ATP III Lipid and Lipoprotein Classification (continued) Total Cholesterol (mg/dL)
<200 Desirable
200–239 Borderline high
?240 High
31. 31 Specific Dyslipidemias: Elevated Triglycerides Classification of Serum Triglycerides
Normal <150 mg/dL
Borderline 150–199 mg/dL
High 200–499 mg/dL
Very high ?500 mg/dL
32. 32 Specific Dyslipidemias: Elevated Triglycerides (?150 mg/dL) Causes of Elevated Triglycerides
Obesity and overweight
Physical inactivity
Cigarette smoking
Excess alcohol intake
33. 33 Specific Dyslipidemias: Elevated Triglycerides Causes of Elevated Triglycerides (continued)
High carbohydrate diets (>60% of energy intake)
Several diseases (type 2 diabetes, chronic renal failure, nephrotic syndrome)
Certain drugs (corticosteroids, estrogens, retinoids, higher doses of beta-blockers)
Various genetic dyslipidemias
34. 34 Specific Dyslipidemias: Elevated Triglycerides (continued) Non-HDL Cholesterol: Secondary Target
Non-HDL cholesterol = VLDL + LDL cholesterol = (Total Cholesterol – HDL cholesterol)
VLDL cholesterol: denotes atherogenic remnant lipoproteins
Non-HDL cholesterol: secondary target of therapy when serum triglycerides are ?200 mg/dL (esp. 200–499 mg/dL)
Non-HDL cholesterol goal: LDL-cholesterol goal + 30 mg/dL
35. 35 4. Other risk factors: DM: CHD is 2- 3 times higher in diabetics
FH CHD increase the risk of premature death.
Physical activity
Type A personality
High alcohol intake
Oral contraceptives
Hormones: difference between men and women
36. 36 Prevention of CHD: CHD is preventable. I. Prmary prevention: 1. Control of risk factors among populations: a) Dietary changes: - Reduction of fat intake (saturated, cholesterol ) - Avoid alcohol consumption. b) Smoke free society c) Blood pressure: d) Physical activity: 2. Identification of high risk groups: specific advice.
37. 37 Prevention of CHD: II. Secondary prevention: Prevent recurrence and regression of CHD: a) Screening high risk groups & suitable Rx. b) Drugs, coronary surgery, pace- makers.. etc. c) Control of risk factors i.e. smoking, HTN, DM diets, exercise... etc.
38. 38 Prevention of CHD: III Tertiary prevention: Rehabilitation irreversible limitations of cardiac function through:
changes in behavior, habits, life- styles, diets,
use of drugs,
occupational rehabilitation,
control of risk factors
psychological rehabilitation
39. 39 Hypertension
40. 40 Classification
Normal < 120/ < 80
Prehypertension 120-139/80-89
Hypertension ; stage -1 : 140-159/90-99
Hypertension ; stage -2 : > 160+/ 100 +
41. 41 Hypertension In KSA Magnitude of The Problem 1. Public and professional awareness is lacking greatly
2. In our country (and many other developing countries) this issue is not adequately addressed by any organization
42. 42 Magnitude of HTN in SA 3. Open market for all possible drugs
4. Many misconceptions regarding hypertension and its treatment by the public, too much trust into herbs
5. Medical professionals belong to too many “schools” with diverse treatment traditions and standards
43. 43 Magnitude of the HTN2 6. Not adequately recognized as an important life-long risk for other more “attractive” diseases such as
CRF,
Stroke and
MI, at least until recently
All above affect all aspects of management of HTN in SA
44. 44 Prevalence of hypertension in KSA
45. 45
46. 46 Prevalence in some countries
47. 47 Worldwide
48. 48 Socioeconomic implications of untreated hypertension In USA Cost of Hypertension: $47.2 billion (NHLBI 2003). In 50 million people.
In KSA let say we pay ˝ of this for 4 millions of Saudis = 8 billion SR???
49. 49
50. 50 What is needed? Educate the professionals on prevention and treatment of HTN.
Improve the teaching on life style-modifications to the medical and general public
Improve the general public awareness of the importance of normalized BP.
51. 51 What we need? Cooperate with policy makers to project multitudes of actions to fight HTN through out the society all year long
Develop training packages for health care providers in prim. care centers.
Cooperate with national and international organizations to learn from each others experience.
52. 52 Management Plan Establish Good patient relationship.
Educate patient & family on the consequences
Encourage Self monitoring.
BP goal.
Non pharmacological therapy.
Pharmacological therapy.
Simplify drug regimen.
Elderly.
53. 53 Diabetes Mellitus (DM)
54. 54 Diabetes Mellitus (DM) It is a chronic disease due to deficiency or diminished effectiveness of insulin. The disease affects the metabolism of carbohydrates, proteins, fats, water and electrolytes.
55. 55 Classification DM: I. Diabetes mellitus: 1. Insulin dependant = Juvenile onset (IDDM, type 1). 2. Non insulin dependant DM = Maturity onset (NIDDM, type II). II. Impaired glucose tolerance: intermediate state between DM and normality, pregnancy state, obesity and stress may precipitate this condition. III. Gestational DM: Pregnancy induced.
56. 56
57. 57 Severity DM: IDDM is the most lethal form,abrupt onset.
NIDDM is the commonest presentation,
with gradual onset,
mild nature of the disease
compatible with long living with adequate control.
58. 58 Magnitude of DM: Most common metabolic diseases of human beings.
The prevalence worldwide two to six percents.
Developing countries, DM masked by communicable diseases as well as malnutrition.
Higher rates of occurrence are found in developed countries
DM is the eighth leading cause of death in USA.
Diabetics are incapacitated by many serious complications as atherosclerotic diseases, renal failure, neuropathy and blindness.
59. 59 Aetiology DM: The fundamental cause unknown,
Several theories suggest different causative mechanisms.
Inherited & exposure factors accumulate to produce DM
The primary agent is insulin deficiency, genetic, pancreatic
Insulin available in normal amounts but of defective nature
Peripheral tissues may have decreased sensitivity to it.
60. 60 Diabetes in relation to pregnancy: a) Adult type DM which manifests itself for the first time during pregnancy. b) Gestational DM that disappears with the end of pregnancy.
61. 61 Magnitude of Gestatinal DM: It has been estimated that 10,000 babies are born to women with diabetes every year in developed countries.
The possibility of occurrence rises with higher parity and age of pregnant female
incidence rates of diabetes in pregnant women range from 0.1 to 0.5 every 100 pregnancies.
62. 62 Morbid effects: 1. Maternal complications ,Higher incidence of pre-eclampsia, eclampsia, infections and post partum haemorrhage.
2. Fetel and child Morbidity from birth trauma, deranged metabolism and congenital anomalies .
63. 63 Epidemiology DM: Person: NIDDM increases with age.
IDDM,rises gradually from early childhood to a peak at 10-12, then starts to decline from early adolescence.
There are more young male diabetics than females.
In middle age, women are more affected because of pregnancy.
Genetic: Undisputed aggregation of cases in families are found in DM.
- Immune mechanism: Cell mediated
- Body weight: obesity.
- Diet:
64. 64 Diseases Incriminated in DM: 1)Viruses: e.g. rubella, mumps, coxackie ,cytomegalo
2)Endocrine: acromegaly,Cushing’s, thyrotoxicosis.
- Behavior and stress: Lack of exercise and Stress (example: trauma, surgery or psychic troubles. .etc.) may bring out the disease.
65. 65 Epidemiology DM: II. Place: DM is commoner in developed countries.
different age structure of population
better facilities of diagnosis
stress
sedentary occupations.
66. 66 Epidemiology DM: III. Time 1 DM is on the increase due to prolongation of life span, changing life styles, better diagnosis and improved medical care
2 Seasonality: IDDM peak incidence is recorded in winter months (suggesting flactulating viral diseases).
67. 67 Prevention DM: I. Primary Prevention: Identification of those at risk:
1. Individuals with positive family history
2. Those over 40 years of age. 3. Obese individuals. 4 Females with suggestive obstetric history
5. Cases with premature atherosclerosis. b) Health education:
I Maintenance of optimal body weight 2. Promotion of physical exercise. 3. Diet modification
4.Avoidance of diabetogenic drugs. e.g. contraceptive pills, corticostroids. 5.Family life education: avoidance of marriage among diabetics
6. Prevention of pregnancy
68. 68 Prevention DM: II. Secondary prevention: a) Screening: The preventive significance of early detection is two fold:
1.Discovery of the disease in its pre-symptomatic state if followed by adequate treatment minimize the danger of complications such as coma and infection.
2.Early therapy reduces the progress of disease and may reverse the pathologic changes.
Chronic hyperglycemia exhausts the already weak islets of Langerhans (insulin producing cell).
Diabetics with no or minimal complications at the time of diagnosis have a death rate less than one third that of patients with serious complications at time of diagnosis.
All risk groups should be screened periodically.
69. 69 Prevention DM: II. Secondary prevention: a) Screening: Tests for screening: Detection of glucose in urine two hours after a meal are considered diabetics unless proved otherwise.
Mild cases may escape diagnosis when there is no glucostirea. This lack of sensitivity may miss up to 50% of cases (false negative).
Reliable results are obtained two hours after 75 grains oral glucose. 180 rng/dl blood is threshold value for diagnosing diabetes.
Any organized group of the community can be the target of a screening program for diabetes. Example: Workers covered by health insurance, mothers attending MCH centers, school children, labourers in factories . . . etc.
70. 70 Prevention DM: II. Secondary prevention: b) Treatment: Aim is to maintajn serum glucose within normal: 1.by diet modification alone,
2.diet and oral hypoglycemic drugs
3.or diet and insulin.
NB.controlled diabetics life expectation is approximating that of general
71. 71 Prevention DM: II. Secondary prevention: c) Health education: as in counsellig individual patients or Group education in organized session it should cover the following: . 1. Maintain the ideal body weight
2. Train diabetic for self care as it is crucial for good prognosis.
to stick to treatment measures
to detect dangerous signs and symptoins.
The diabetic should be able to test his blood, choose his diet, regulate his physical activities, administer his own -and even adjust- his daily insulin dosage.
3. Health education should also stress the use of diabetic cards.
72. 72 Prevention DM: III. Tertiary prevention: Treat complications and rehabilitate patient to lead a life as normal as possible.
periodic checkups for visual acuity (retinopathy), renal functions (nephropathy), and testing peripheral nerves sensation (neuropathy
Diabetics cards which provide information needed for emergency situations as hypoglycemic and ketoacidotic episodes.
73. 73 Cancer Cancer emerges as a major public health problem not only in developed countries, but also in many developing countries.
74. 74 Cancer Definition: cancer can be regarded as a group of diseases characterized by the following: 1. Abnormal growth of cells. 2. Ability to invade adjacent tissues and even distant organs. 3. The eventual death of the affected patient if the tumor has progressed beyond that stage when it can be successfully removed.
75. 75 Magnitude of the CA problem: All forms are causing 9% of deaths throughout the world.
At the beginning of this centuary, sixth cause of death in developed countries.
Today, it is the second leading cause of death next to cardiovascular diseases in these countries.
In developing world, it ranks fourth as a cause of death.
76. 76 Magnitude of the CA problem: There is a steady increase in incidence and mortality. This could be explained by : 1.Techniques for case-finding & detection.
2. Control of communicable diseases .
3. Marked demographic aging.
4 .Changes in life style and environment
77. 77 Geographic distribution &place CA: The international variations in pattern attributed to multiple factors such as enviromnental, food habits, life style, genetic inadequacy in detection and reporting ,population structure.
For example, cancer of the stomach is common in Japan, and has a low incidence in United States.
Or the other hand, breast cancer is common in United States and has a low incidence in Japan.
In Egypt, due to the prevalence of bilharzia, cancer bladder is more common than in areas where there is no bilharzia. Also it was observed that cancer mortality is highest in urban and industrial communities, and lowest in mountain.areŕs.
78. 78 Person characteristics and CA Age: Mortality is low during infancy and preschool years, and drops to its minimum level during subsequent childhood period.
At older ages the rate rises consistantly to a peak.
More than half the cancer deaths today are persons aged 65 years and over.
79. 79 Person characteristics and CA Sex: In general more frequently in females than in males.But, the following is observed:
a) Incidence of cancer lip, larynx, lung, bronchus, tongue, pharynx and oesophagus is higher among males than females. b) Cancer of thyroid and biliary passages is more among females. c) Gastro-intestinal tract cancer is equally distributed among males and fčmales.
80. 80 Person characteristics and CA Ethnic hackgrounI: Cancer is more among non- whites, this can be attributed to the increase of cancer of digestive and genital system especially for males.
On the other hand, skin cancer is more among white race.
81. 81 Person characteristics and CA ReIigion: Both Jewish and Moslem women have very low rates of cervical cancer, a point which has variously ascribed to hygienic practices associated with sexual habits and male circumcision.
82. 82 Person characteristics and CA Marital status: Cancer cervix occurs more in sexually active women. Cancer breast is more common among the’ unmarried.
83. 83 Person characteristics and CA Socio- economic status: inverse association between cervical cancer and socio- economic status
On the contrary, breast cancer was found to occur more commonly among women of high social standards.
This differences may be due to differences in the life style, dietary pattern, marital practices, fertility pattern and personal hygiene.
84. 84 Etiology of cancer: As with other chronic diseases, cancer has a multifactorial aetiology.
I . Genetic factor
2. Personal habits
3. Dietary factors
4. Occupational exposures
5. Infection
6. Physical agents
7. Chemical agents
85. 85 Cancer prevention a series of measures based on medical knowledge in the fields of prevention, detection, diagnosis, treatment, after care and rehabilitation.
This aimed at reducing the number of new cases, increasing the number of cures and reducing the invalidism due to cancer.
It is estimated that at least one third of all cancers are preventable.
86. 86 Cancer prevention 1. Primary prevention:
a) Health education: tobacco and alcohol , hygiene , immunization , detection and treatment
b) Industrial and occupational control:
c) Environmetal pollution:
87. 87 Cancer prevention 2. Secondary prevention
a) Early detection of cases
b) Treatment
88. 88 Cancer prevention 3. Tertiary prevention:
a) Pain relief b) Rehabilitation and psychological support
89. 89 Without action, an estimated 388 million people will die from chronic diseases in the next 10 years. Many of these deaths will occur prematurely, affecting families, communities, and countries.
The situation requires a rapid response that must above all be forward-looking. The vision for the future should focus on reducing deaths and improving lives.
Without action, an estimated 388 million people will die from chronic diseases in the next 10 years. Many of these deaths will occur prematurely, affecting families, communities, and countries.
The situation requires a rapid response that must above all be forward-looking. The vision for the future should focus on reducing deaths and improving lives.
90. 90 10 widespread misunderstandings about chronic disease - and the reality Chronic disease epidemic is rapidly evolving
Global recognition and response has not kept pace
Misunderstandings can be dispelled by the strongest evidence Several misunderstandings have contributed to the neglect of chronic diseases. Notions that chronic diseases are a distant threat and are less important and serious than some infectious diseases can be dispelled by the strongest evidence.
Several misunderstandings have contributed to the neglect of chronic diseases. Notions that chronic diseases are a distant threat and are less important and serious than some infectious diseases can be dispelled by the strongest evidence.
91. 91 10. Reality: 80% of chronic disease deaths are in low and middle income countries.10. Reality: 80% of chronic disease deaths are in low and middle income countries.
92. 92 9. Reality: Low and middle income countries are at the centre of old and new public health challenges. While they continue to deal with the problems of infectious diseases, they are in many cases experiencing a rapid upsurge in chronic disease risk factors and deaths, especially in urban settings. These risk levels foretell a devastating future burden of chronic diseases in these countries.
9. Reality: Low and middle income countries are at the centre of old and new public health challenges. While they continue to deal with the problems of infectious diseases, they are in many cases experiencing a rapid upsurge in chronic disease risk factors and deaths, especially in urban settings. These risk levels foretell a devastating future burden of chronic diseases in these countries.
93. 93 Reality: chronic diseases are concentrated among the poor 8. Reality: In all but the least developed countries of the world, the poor are much more likely than the wealthy to develop chronic diseases, and everywhere are more likely to die as a result. Moreover, chronic diseases cause substantial financial burden, and can push individuals and households into poverty.
8. Reality: In all but the least developed countries of the world, the poor are much more likely than the wealthy to develop chronic diseases, and everywhere are more likely to die as a result. Moreover, chronic diseases cause substantial financial burden, and can push individuals and households into poverty.
94. 94 Roberto Severino Campos lives in a shanty town on the outskirts of Sao Paulo in Brazil. He had a history of high blood pressure, before he was disabled by multiple strokes. Now, paralysed and unable to work, Roberto is entirely dependant on his family to survive. The whole Campos family have fallen into a downward spiral of worsening impoverishment.
People who are already poor are the most likely to suffer financially from chronic diseases, which often deepen poverty and damage long-term economic prospects.
Roberto Severino Campos lives in a shanty town on the outskirts of Sao Paulo in Brazil. He had a history of high blood pressure, before he was disabled by multiple strokes. Now, paralysed and unable to work, Roberto is entirely dependant on his family to survive. The whole Campos family have fallen into a downward spiral of worsening impoverishment.
People who are already poor are the most likely to suffer financially from chronic diseases, which often deepen poverty and damage long-term economic prospects.
95. 95 7.Reality: Almost half of chronic diseases occur prematurely, in people under 70 years of age. One quarter of all chronic disease deaths occur in people under 60 years of age.
In low and middle income counties, middle-aged adults are especially vulnerable to chronic diseases. People in these countries tend to develop disease at younger ages, suffer longer – often with preventable complications – and die sooner than those in high income countries.
7.Reality: Almost half of chronic diseases occur prematurely, in people under 70 years of age. One quarter of all chronic disease deaths occur in people under 60 years of age.
In low and middle income counties, middle-aged adults are especially vulnerable to chronic diseases. People in these countries tend to develop disease at younger ages, suffer longer – often with preventable complications – and die sooner than those in high income countries.
96. 96 Mariam John from the United Republic of Tanzania exemplifies that chronic diseases do occur in young people. Mariam is only 13 years old and she is battling bone cancer. Despite this terrible ordeal, Mariam remembers how to smile and is optimistic that she will be cured. Unfortunately, without the necessary facilities and treatment her future looks very uncertain. Mariam John from the United Republic of Tanzania exemplifies that chronic diseases do occur in young people. Mariam is only 13 years old and she is battling bone cancer. Despite this terrible ordeal, Mariam remembers how to smile and is optimistic that she will be cured. Unfortunately, without the necessary facilities and treatment her future looks very uncertain.
97. 97 6. Reality: Chronic diseases, including heart disease, affect women and men almost equally.
6. Reality: Chronic diseases, including heart disease, affect women and men almost equally.
98. 98 Shakeela Begum, now 65 years old, had a heart attack 10 years ago. She hasn't fully recovered from this ordeal and constantly lives in fear of having another heart attack. For financial reasons, Shakeela does not buy a sufficient amount of medication and therefore does not take the prescribed dose. She argues that by doing this she can save money for her grandchildren who are young and have a future.
Some 3.6 million women will die from coronary heart disease in 2005. More than eight out of 10 of these deaths will occur in low and middle income countries.
Shakeela Begum, now 65 years old, had a heart attack 10 years ago. She hasn't fully recovered from this ordeal and constantly lives in fear of having another heart attack. For financial reasons, Shakeela does not buy a sufficient amount of medication and therefore does not take the prescribed dose. She argues that by doing this she can save money for her grandchildren who are young and have a future.
Some 3.6 million women will die from coronary heart disease in 2005. More than eight out of 10 of these deaths will occur in low and middle income countries.
99. 99 Reality: poor and children have limited choice 5. Reality: Individual responsibility can have its full effect only where individuals have equitable access to a healthy life, and are supported to make healthy choices.
Childhood overweight and obesity is a rising global problem. About 22 million children aged under five years are overweight. Reports of type 2 diabetes in children and adolescents – previously unheard of – have begun to mount worldwide.
5. Reality: Individual responsibility can have its full effect only where individuals have equitable access to a healthy life, and are supported to make healthy choices.
Childhood overweight and obesity is a rising global problem. About 22 million children aged under five years are overweight. Reports of type 2 diabetes in children and adolescents – previously unheard of – have begun to mount worldwide.
100. 100 It is unfair to believe that people have only themselves and their lifestyle to blame, individual responsibility is important but governments and societies must provide supportive environments, where healthy choices are easy and accessible. Malri Twalib lives with his mother Fadhila in a small village at the base of Kilimanjaro in Tanzania. She would do anything for her precious son, but feeding him fresh fruit and vegetables is simply not within her budget. As a result Malri has a diet of high calorie, fatty foods. He simply eats too much for a 5 year old boy. Malri is obese. Fortunately village health workers have intervened, encouraging Malri to eat less, and play more. It is unfair to believe that people have only themselves and their lifestyle to blame, individual responsibility is important but governments and societies must provide supportive environments, where healthy choices are easy and accessible.
101. 101 Reality: 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable 4. Reality: the major causes of chronic diseases are known, and if these risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented.4. Reality: the major causes of chronic diseases are known, and if these risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented.
102. 102 Reality: inexpensive and cost-effective interventions exist 3. Reality: a full range of chronic disease interventions are very cost-effective for all regions of the world, including sub-Saharan Africa. Many of these solutions are also inexpensive to implement.
The ideal components of a medication to prevent complications in people with heart disease, for example, are no longer covered by patent restrictions and could be produced for little more than one dollar a month.3. Reality: a full range of chronic disease interventions are very cost-effective for all regions of the world, including sub-Saharan Africa. Many of these solutions are also inexpensive to implement.
The ideal components of a medication to prevent complications in people with heart disease, for example, are no longer covered by patent restrictions and could be produced for little more than one dollar a month.
103. 103 Reality: these people are the rare exceptions Another set of misunderstandings arises from kernels of truth. In these cases, the kernels of truth are distorted to become sweeping statements that are not true. Because they are based on the truth, such half-truths are among the most ubiquitous and persistent misunderstandings. Two principal half truths are presented:
2. Reality: Outliers inevitably exist, but they are extremely rare. The vast majority of chronic disease can be traced back to the common risk factors, and can be prevented by eliminating these risks.
Another set of misunderstandings arises from kernels of truth. In these cases, the kernels of truth are distorted to become sweeping statements that are not true. Because they are based on the truth, such half-truths are among the most ubiquitous and persistent misunderstandings. Two principal half truths are presented:
2. Reality: Outliers inevitably exist, but they are extremely rare. The vast majority of chronic disease can be traced back to the common risk factors, and can be prevented by eliminating these risks.
104. 104 Sridhar represents this reality as his many years of tobacco and alcohol use ultimately led to cancer. To pay for his medical bills, Sridhar borrowed money that he worried he would never be able to repay. Sadly, Sridhar died only a short time after he was interviewed.
Each year, around 5 million people die as a result of tobacco use.Sridhar represents this reality as his many years of tobacco and alcohol use ultimately led to cancer. To pay for his medical bills, Sridhar borrowed money that he worried he would never be able to repay. Sadly, Sridhar died only a short time after he was interviewed.
Each year, around 5 million people die as a result of tobacco use.
105. 105 Reality: death is inevitable but it does not need to be slow, painful or premature 1. Reality: Certainly, everyone has to die of something, but death does not need to be slow, painful, or premature.1. Reality: Certainly, everyone has to die of something, but death does not need to be slow, painful, or premature.
106. 106 Most chronic diseases do not result in sudden death. Rather, they are likely to cause people to become progressively ill and debilitated, especially if their illness is not managed correctly.
Jonas Justo Kassa suffered from the symptoms of diabetes for many years before seeking help. After he was finally diagnosed with diabetes, the next couple of years were an immense relief as Jonas underwent medical treatment and changed his dietary and drinking habits. But Jonas didn't stick to his healthier ways for long eventually resulting in the amputation of both his legs – complications that could have been avoided. Feeling doomed and lonely, Jonas died in his home at the age of 65.
Death is inevitable, but a life of protracted ill-health is not. Chronic disease prevention and control helps people to live longer and healthier lives.
Most chronic diseases do not result in sudden death. Rather, they are likely to cause people to become progressively ill and debilitated, especially if their illness is not managed correctly.
Jonas Justo Kassa suffered from the symptoms of diabetes for many years before seeking help. After he was finally diagnosed with diabetes, the next couple of years were an immense relief as Jonas underwent medical treatment and changed his dietary and drinking habits. But Jonas didn't stick to his healthier ways for long eventually resulting in the amputation of both his legs – complications that could have been avoided. Feeling doomed and lonely, Jonas died in his home at the age of 65.
Death is inevitable, but a life of protracted ill-health is not. Chronic disease prevention and control helps people to live longer and healthier lives.
107. 107 The global goal A 2% annual reduction in chronic disease death rates worldwide, per year, over the next 10 years.
The scientific knowledge to achieve this goal already exists. The target for this goal is an additional 2% annual reduction in chronic diseases death rates over the next 10 years to 2015.
The scientific knowledge to achieve this goal already exists.
Pursuing this goal would result in 36 million chronic disease deaths averted by 2015.
The target for this goal is an additional 2% annual reduction in chronic diseases death rates over the next 10 years to 2015.
The scientific knowledge to achieve this goal already exists.
Pursuing this goal would result in 36 million chronic disease deaths averted by 2015.
108. 108 9 out of 10 lives saved: low and middle income countries Every death averted is a bonus, but the goal contains an additional positive feature: almost half of these averted deaths would be in men and women under 70 years of age and almost nine out of 10 of these would be in low and middle income countries. Extending these lives for the benefit of the individuals concerned, their families and communities is in itself the worthiest of goals.
Every death averted is a bonus, but the goal contains an additional positive feature: almost half of these averted deaths would be in men and women under 70 years of age and almost nine out of 10 of these would be in low and middle income countries. Extending these lives for the benefit of the individuals concerned, their families and communities is in itself the worthiest of goals.
109. 109 Economic gain: billions The averted deaths would also translate into substantial labour supply gains.
Achievement of the global goal would result in an accumulated economic growth of $36 billion in China, $15 billion in India and $20 billion in the Russian Federation over the next 10 years.The averted deaths would also translate into substantial labour supply gains.
Achievement of the global goal would result in an accumulated economic growth of $36 billion in China, $15 billion in India and $20 billion in the Russian Federation over the next 10 years.
110. 110 What works? Comprehensive and integrated action is the means to prevent and control chronic diseases Chronic diseases can be prevented and controlled using available knowledge.
The stepwise framework offers a flexible and practical public health approach to assist ministries of health in balancing diverse needs and priorities while implementing evidence-based interventions.
Comprehensive and integrated action is required.
Comprehensive action requires combining population-wide approaches that seek to reduce the risks throughout the entire population with strategies that target individuals at high risk. Even a small shift in the average population levels of several risk factors can lead to a large reduction in the burden of chronic disease.
Integrated prevention and control strategies are most effective. Integrated approaches focus on the common risk factors: unhealthy diet, physical inactivity and tobacco use. They deal with a number of related diseases such as heart disease, stroke and diabetes, at the same time.
Chronic diseases can be prevented and controlled using available knowledge.
The stepwise framework offers a flexible and practical public health approach to assist ministries of health in balancing diverse needs and priorities while implementing evidence-based interventions.
Comprehensive and integrated action is required.
Comprehensive action requires combining population-wide approaches that seek to reduce the risks throughout the entire population with strategies that target individuals at high risk. Even a small shift in the average population levels of several risk factors can lead to a large reduction in the burden of chronic disease.
Integrated prevention and control strategies are most effective. Integrated approaches focus on the common risk factors: unhealthy diet, physical inactivity and tobacco use. They deal with a number of related diseases such as heart disease, stroke and diabetes, at the same time.
111. 111 In many ways, we are the heirs of the choices that were made by previous generations: politicians, business leaders, financiers, and ordinary people. Future generations will in turn be affected by the decisions that we make today.
Each of us has a choice: whether to continue with the status quo, or to take up the challenge and invest now in chronic disease prevention.
Without action, an estimated 388 million people will die from chronic diseases in the next 10 years. Likewise, countries will forego billions in national income.
With increased investment in chronic disease prevention, it will be possible to prevent 36 million premature deaths in the next 10 years. Averted deaths would in turn translate into substantial economic gains.
The knowledge of how to prevent these diseases is available now. The way forward is clear. It’s our turn to take action!
In many ways, we are the heirs of the choices that were made by previous generations: politicians, business leaders, financiers, and ordinary people. Future generations will in turn be affected by the decisions that we make today.
Each of us has a choice: whether to continue with the status quo, or to take up the challenge and invest now in chronic disease prevention.
Without action, an estimated 388 million people will die from chronic diseases in the next 10 years. Likewise, countries will forego billions in national income.
With increased investment in chronic disease prevention, it will be possible to prevent 36 million premature deaths in the next 10 years. Averted deaths would in turn translate into substantial economic gains.
The knowledge of how to prevent these diseases is available now. The way forward is clear. It’s our turn to take action!
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