.-. .

Noncommunicable Diseases World Health OrganizationECOSOC High-level Segment

Affordable solutions exist to prevent 40 to 50% of premature deathsfrom noncommunicable diseases

These solutions can prevent an estimated14 million premature deaths each year in developing countries

Figure 3: No. of Deaths (2002-2006) and Projected global deaths (millions) for major chronic disease groups and other causes of death in Thai population and 23 selected countries, 200515 (CHD = coronary heart disease; COPD = Chronic lower respiratory diseases)

: (.2549) * TBRFSS2548 ** TNHEXAM2546

Risk Factors **MiIllionsOverweight and Obesity~ 16.1 Low fruits and vegetable Diet~ 38 Physical Inactivity~ 19 Hypertensive Diseases~ 7.4 Diabetes~ 3.4

Burden of Major Thai Chronic NCDs in 2005Source: BNCD (.2006) esttimated from * TBRFSS2548 *

Diseases*MillionsStroke and ISHD~ 0.9 Chronic Renal Failure~ 1.8 Cancer~ 0.2 COPD and Asthma~ 1.6 Depression~ 0.6

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5.41122

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Hypertension Prevalence * in NHEXAMIII (2004)* Notice that this figure included persons who told by health personnel have hypertension or have BP level systolic >= 140 or diastolic >= 90 mmHg. Analysed by Bureau of Noncommunicable Diseases; Dept. Of CDC; MOPH.not allowed to reference yet1991 = 5.4%; 1996 = 11%, 2004 = 22%

MaleFemaleTotalAgeNoPrevalence (%)NoPrevalence (%)NoPrevalence (%)15-24312.20191.53501.9425-341045.09724.191764.6335-443029.972939.325959.6245-5991622.17120026.77211624.6260-69206035.15220236.53426235.9170-79133037.07151939.73284938.5880+27435.5628038.5355437.19Total501714.97558517.581060216.32

Diabetes Prevalence * in NHEXAMIII (2004)* Notice that this figure included only persons who told by health personnel have diabetes or have Blood sugar level >= 126 mg%Analysed by Bureau of Noncommunicable Diseases; Dept. Of CDC; MOPH.not allowed to reference yet1991 = 2.3%, 1996 = 4.6%, 2004 = 6.9%

MaleFemaleTotalAgeNoPrevalence (%)NoPrevalence (%)NoPrevalence (%)15-240030.304130.128425-3460.4115130.764190.590135-44542.0894773.30221312.739745-592135.02263608.73685736.999960-694867.77774712.9398123310.636970-792677.372740910.38116769.0880+313.0895384.8835694.076Total10573.04516475.547327044.3433

Causative Factors (Advanced epidemiology triangle for chronic diseases and behavioral disorders)

280151

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: (MAURITIUS) .. (CROSS-SECTIONAL CLUSTER SURVEYS)Dowse et al; BMJ, 1995

RESULTSMEN WOMEN15% 12.1%12.4% 10.9% 58% 47.2% 6.9% 3.7%38.2% 14.4% 2.6% 0.6%

MODERATE LTPA16.9% 22.1% 1.3% 2.7%MEAN POPULATION SERUM CHOLESTEROL 5.5mmol/l 4.7mmol/lOVERWEIGHT/OBESITY ; GLUCOSE INTOLERANCE -NS

GLOBAL FORUMon NCD prevention and control 9-12 Nov 03 Rio de Janeiro

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GLOBAL FORUMon NCD prevention and control 9-12 Nov 03 Rio de Janeiro

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GLOBAL FORUMon NCD prevention and control 9-12 Nov 03 Rio de Janeiro

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15.01.51. ..... ...... ..... ..... ..... ..... ........

15.01.51

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T580 -

1)To raise the priority accorded to NCDs in development work at global and national levels, and to integrate prevention and control of such diseases into policies across all government department

6.2)To monitor noncommunicable diseases and their determinants and evaluate progress at the national, regional and global levels

4 (Surveillance & Care System) (4.1)

5 (Capacity Building) (5.4)

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% 0f DALYS and Major Risk Factors Attributed in 2004Ref.: Report of Burden of Diseases 2004; printed in process. Bureau of Policy and Plan, Ministry of Public Health Thailand.

Continuous Risks of Blood Pressure, Cholesterol, and Body Mass Index and Coronary Heart Disease Riska. Blood pressure b. Cholesterol c. Body mass indexRelative risk of CHD Relative risk of CHD Relative risk of CHDSystolic blood pressure (mmHg)Total cholesterol (mmol/l)Body mass index (kg/m2)Source: Disease Control Priorities in Developing Countries Anthony Rodgers, Carlene M. M. Lawes, Thomas Gaziano, and others

(Population & High-risk Based Management Strategies)

Dele O Abegunde, Colin D Mathers, Taghreed Adam, Monica Ortegon, Kathleen Strong. The burden and costs of chronic diseases in low-income and middle-income countries. www.thelancet.com Vol 370 December 8, 2007. .. 2545-2549 : :

** ..2548 (%) () 8.31; 3,703,297. 3.69; 1,597,326 0.88; 396,408 10.7; 478,785 1.08; 483,865 0.48; 213,777 0.40; 179,551 1.31; 585,788 4.10; 1,824,351**

Scaling up interventions for chronic disease prevention: the evidence Dr Thomas A Gaziano MD a , Gauden Galea MD b, K Srinath Reddy MD c

SummaryInterventions to prevent morbidity and mortality from chronic diseases need to be cost effective and financially feasible in countries of low or middle income before recommendations for their scale-up can be made. We review the cost-effectiveness estimates on policy interventions (both population-based and personal) that are likely to lead to substantial reductions in chronic diseasesin particular, cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We reviewed data from regions of low, middle, and high income, where available, as well as the evidence for making policy interventions where available effectiveness or costeffectiveness data are lacking.

The results confirm that the cost-effectiveness evidence for tobacco control measures, salt reduction, and the use of multidrug regimens for patients with high-risk cardiovascular disease strongly supports the feasibility of the scale-up of these interventions. Further assessment to determine the bestnational policies to achieve reductions in consumption of saturated and trans fatchemically hydrogenatedplant oilscould eventually lead to substantial reductions in cardiovascular disease. Finally, we reviewevidence for policy implementation in areas of strong causality or highly probable benefiteg, changes inpersonal interventions for diabetes reduction, restructuring of health systems, and wider policy decisions.

SeriesThe Lancet, Volume 370, Issue 9603, Pages 1939 - 1946, 8 December 2007http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61697-3/fulltext

****The Regional Approach seeks to effect change simultaneously at 3 levels:At the environmental level, through policy and regulatory interventions;At the level of common and intermediate risk factors, through population-based lifestyle interventions;At the level of early and established disease, trough clinical interventions targeted at high risk individuals.

Advocacy, research and surveillance, political and community leadership, intersectoral partnerships and community mobilization and health systems strengthening underpin each of these levels where action is needed, and comprise the remaining 4 action areas.

*: * ( A Sustainable Health Care System) 8 , Rachlis, M.. Presentation to the 38th Annual Mackid Symposium on Chronic Disease Management Winnipeg, MB May 13, 2004.

*CHD = coronary heart disease

*

Figure 5Pictorial representation of the distribution of risk for cardiovascular disease, and high-risk and population-based management strategies.Vasc Health Risk Manag. 2007 October; 3(5): 587603. Published online 2007 October. Copyright 2007 Dove Medical Press Limited. All rights reserved

*