Non communicable diseases

1. Non communicable diseases Thomas Abraham

2. What are non- communicable diseases? • How big a problem are they? • Sources of information • Challenges in reporting non-communicable diseases

3. What are NCDs? • Diseases or conditions that are not transmissible, or caused by injury • Cardiovascular disease, cancer, diabetes, chronic respiratory diseases ( asthma, other pulmonary diseases)

4. Distribution of deaths by leading cause groups, males and females, world, 2004

6. Leading causes of disease burden for women aged 15–44 years, high-income countries, and low- and middle-income countries, 2004

7. Poor countries face a “double burden” of disease: both infectious diseases as well as a growing burden of non-communicable diseases.

8. http://www.who.int/cardiovascular_diseases/resources/atlas/en/http://www.who.int/cardiovascular_diseases/resources/atlas/en/

18. Cause, effect and risk factors • When a direct cause and effect cannot be established, but there is a strong statistical relationship between a disease and an agent, the agent is a risk factor. • Cholesterol, elevated blood pressure, and obesity are risk factors for coronary disease • We do not know if they directly cause heart disease, but they increase the risk of getting heart disease. • Eg. You can have low cholesterol levels and have coronary artery disease; you can have high cholesterol and not have coronary artery disease.

19. Cancer- the emperor or all maladies • 7.6 million deaths (around 13% of all deaths) in 2008. -lung (1.37 million deaths) -stomach (736 000 deaths) -liver (695 000 deaths) -colorectal (608 000 deaths) -breast (458 000 deaths) -cervical cancer (275 000 deaths)

22. What is cancer? • Arises from a single cell- rapid creation of abnormal cells that grow and can spread to other organs and parts of the body (metastasis) • Also known as malignant tumours, neoplasms • Stages: normal- pre cancerous-malignant tumours

23. Causes? • Interaction between genetic factors and external agents: -physical carcinogens ie. ionizing radiation -chemical carcinogens ie asbestos, tobacco smoke -biological carcinogens ie viral and bacterial infections (eg HPV and cervical cancer)

24. Prevention • Around 30% of cancers can be avoided by reducing the following risk factors: -tobacco use -excessive alcohol use -unhealthy diet -urban air pollution -indoor smoke -sexually transmitted HPV virus

25. Treatment • Destroying and removing the cancer cells through -chemotherapy -radiotherapy -surgery

26. Screening and cancer • Early detection through screening should lead to early detection, early treatment and fewer deaths • But how effective is mass screening for breast cancer? • A controversial topic, with experts on both sides. Both sides say it saves lives, but differ over the risks such as overdiagnosis.

27. Figures from one study • In the UK 5.7 deaths/1,000 women were prevented over a 20 year period of screening. • Absolute risk reduction 28% • Over diagnosed: 2.3/1,000 over 20 years. • Pro screening would argue that benefits are double the risk • Sceptics would say that with women should be told benefits and risks, and decide for themselves. Screening and avoiding are both rational decisions.

28. Globalisation, business and disease • Many of the risk factors for non-communicable diseases arise from the activities of large global corporation • Tobacco, fast food chains, alcohol • There are jobs, share prices, economic activity involved. • How do you balance • Large corporations would say “consumer choice” • Public health would say- regulate

29. http://abcnews.go.com/Health/Wellness/warning-labels-highlight-statin-dangers/story?id=15810244#.T12txoFOBuohttp://abcnews.go.com/Health/Wellness/warning-labels-highlight-statin-dangers/story?id=15810244#.T12txoFOBuo