ATITUDE UJA TABAKU ESTRATEGIA PREVENSAUN IHA TIMOR LESTE
ATITUDE UJA TABAKU ESTRATEGIA PREVENSAUN IHA TIMOR LESTE Many Hands International, 10 July 2015
Ezbosa/Outline Aprezentasaun Profile Organizasaun MHI 2. Projetu Advokasia Kontrolu Tabaku 3. Konkluzaun Peskija Prevene Uja Tabaku 1. A. Prevalensia Uja Tabaku Iha Timor Leste B. Dalan ba prevensaun
1. Profile Organizasaun MHI �Many Hands International (MHI) (www. manyhands. org. au) Organizasaun husi Australia nebe registradu ona nuudar Organizasaun Non-Govermantais �MHI promove Kultura liu husi projetu komunidade, trainamento profisional, nomos advokasaun publiku �Parseria ho komunidade hodi promove dezemvolvimentu kultura. �Projetu dahuluk liu mak harii sentru kultura no arte kontemporeneu iha Lospalos -Timor Leste.
2. Projetu Advokasia Kontrolu Tabaku q. Parseria Iha inisiu tinan 2014 Many Hands International parseria ho Universidade Deakin Australia hodi dezemvolve Projetu Peskija Prevene Uja Tabaku q. Objetivu ◦ Projetu ne’e prepara data-base no konsulta organizasaun relevante no pesoal sira kona ba dalan prevene uja tabaku. ◦ Bolu atensaun ba prevalensia uja tabaku
Many Hands Organigram Directors 1. Dr Kim Dunphy 2. Holy Schauble Advisors & Members Country Manager & Project Supervisor Lucia Pichler Officer Finance & Adminstration Officer Mentor Officer Cultural Heritage Preservation & Development Early Child Education program Health Promotion & Tobacco Control Advocacy Officer Youth Creative Art Development Mentor Woman Empowerment & Physical wellness development
3. Konkluzaun Peskija Prevene Uja Tabaku INTRODUSAUN Ø Globalmente Epidemia tabacco hamate ema besik miliaun 6 kada tinan Ø Mortalidade >600 000/tinan husi ema fumador pasivu. Ø Bainhira la foti asaun ruma, epidemia bele hamate ema liu husi miliaun 8 iha tinan 2030. Ø >80% husi menus halo prevensaun ba mortalidade mak ema ne’ebe moris iha nasaun sira nebe rendementu kiik inklui mos Timor Leste Ø Industria tabaku iha maneira oi-oin hodi dada konsumedor foun sira hodi nune’e bele mantein no hasa’e faan tabaku no hetan lukru.
A. Prevalensia fuma oras ne’e daudaun ba adultu mane iha Timor Leste India (2009 -2010) Sri Lanka (2006) Nepal (2008) 24% 30% 36% Bangladesh (2009) 45% Myanmar (2009) 45% Thailand (2011) 47% Maldives (2009) 47% Indonesia (2011) Timor-Leste (2009 -2010) 67% 70%
Expozisaun ba fuma passivu iha uma entre labarik foin sa’e sira ho idade 13 -15 Africa South-East Asia Eastern Mediterranean Americas Global Western Pacific Timor Leste (2009) Europe 28% 34% 38% 41% 43% 51% 59% 78%
Fator Risku ba Moras La Hadaet Fator Risku Condition Cardiovascular diseases Diabetes Cancer Uja Tabaku/Fuma √ √ √ Alkohol √ √ √ Menus han ai fuan & modo tahan √ √ √ Konsume masin barak √ √ √ Menus aktividase fizika √ √ √ Obesity √ √ √ Tensaun ran sae √ √ Masmidar barak iha ran √ √ √ Lipido ran la normal √ √ √ Respiratory Conditions √ √ √
Kauza mate tamba Moras Hadaet no Moras La Hadaet iha Timor Leste 100% 4. 2 6. 2 90% 80% 30 42 70% 60% SELUK 50% 40% 30% 65. 8 MLH 51. 8 20% MH 10% 0% 1990 GBD PROFILE: TIMOR-LESTE 2010
Mortalidade no Morbilidade tanba MLH iha Hospital Timor Leste (Jan-Dez 2012) Fonte: Relatóriu Anual Estatistika Saúde Kategoria Moras Admisaun/Baixa Mate Númeru % Moras La hada’et 17193 49. 9 272 22. 2 Moras Kardiovaskular inklui Stroke Diabetes Melitus Moras Respiratória Krónika Moras Hepátika no Renál Moras Nutrisionál 1307 115 531 608 563 3. 8 0. 3 1. 5 1. 8 1. 6 147 16 29 73 21 12. 0 1. 3 2. 4 6. 0 1. 7 Moras Mental no neurolójiku Kanek 183 1416 0. 5 4. 1 0 39 0. 0 3. 2 626 1223* 51. 2 100. 0 Kauza moras la-definidu ka Laespesífiku 12504 36. 3 TOTAL 34420 100. 0 * La inklui mate fetal intrauterina
B. Dalan ba Prevene Uja Tabaku
Resultadu Survey MHI Metode q. Delphi Study Technique q. Treinu iha Deakin University Australia hodi devemvolve abilidade peskija. q. Dezemvolve no Analiza Questionariu iha lian Tetum no Inglesh no aprejenta ba supervisor iha Deakin University q. Identifika Lista Sample Liu husi Belun org. data base no Departementu Administrasaun Distritu Lautem q. Revizaun Literatura Sistematika q. Intervista Pessoal no Grupu Diskusaun q. Analiza Data
Survey iha Municipiu Lautem Data halao survey husi 8 July 2014 too 29 Agusto 2005
Sampel Baboot I. Karakteristika Organizasaun Opsaun Respondente Lideransa Komunidade Suco NGO Departmento Edukasaun Governo Distritu Ofisial Saude Lokal Organizasaun Sosiedade Civil Governo Nasional Universidade Seluk* Total * Refere ba profesores da escolas, estudantes, Lider Relijaun no N % 12 7 7 5 5 4 3 1 6 50 24% 14% 10% 8% 6% 2% 100%
II. Nivel Edukasaun Response Options N % Masters, Ph. D or Equivalent 2 4% Bachelor, Diploma or Equivalent 23 46% Secondary School Completion 17 34% Up to 11 Years Secondary School 2 4% Below 10 Years Secondary School 6 12% Total 50 100%
III. Status servisu partisipantes Opsaun Respondentes Servisu Full Time Servisu Part Time Servisu iha Kapasidae Voluntariu Total N 42 5 % 84% 10% 3 6% 50 100%
Prevene uja tabaku sai isu proridade 35 30 25 20 15 10 5 0 Aseita Makas Aseita natoon La Aseita
Importansia halao Program prevensaun utiliza tabaku Importante Oituan 2% Importate 18% Importante Liu 80%
Aksaun nebe bele foti hodi hatan ba prioridade nee Hapara impor no produs tabaku Regula ho Lei husi governo Edukasaun Saude Bandu no hapara Reklame tabaku Fatin livre Tabaku Taxa & hasae folin Limita Faan Intervensaun Mediku Edukasaun ba Inan aman Hasae tabaku lokal 0 5 10 15 20 25 30 % Fator hatun prevelensia uja tabaku 35 40
Opsaun no Potensia nebe iha hodi halao prevensaun Sansaun ba minoridade Radio/ Media Rede Governu/Lider La faan Tabaku Fatin Livre Tabaku Rekursu Humanu Edukasaun Tabaku tradisaun Menus Kapasidade Koordenasaun kapasidade Village Committee Advokasia 0 5 10 15 20
Kapasidade nebe persija hodi kontrola Tabaku Limita ho Lei 5% Fahe Informasaun/Kampanha Prevensaun 14% Fundus 7% Hasae kapasidade edukasaun saude 52% Hasae Presu 4% Linha Koordenasaun Governu 5% Livre Tabaku Fatin 5% Haforsa Parseria 7%
Konklusaun �Problema tabaku sai ona isu global nebe seriu no dezafiu ba dezemvolvimentu iha Timor Leste �Prevalensia uja tabaku iha Timor Leste fo alarma 70% tuir dadus GYTS 2013 �Tabaku kontribui ba risku MLH nebe oho ema Timor Leste �Fasil atu prevene, maibe difisil atu kura �Governu iha komitmentu maibe falta
ATITUDE UJA TABAKU ESTRATEGIA PREVENSAUN IHA TIMOR LESTE Many Hands International, 10 July 2015
Obrigado
Objetivos � Atu Komprende baze legal no prevalensia Global no Nasional ba Tabaku � Atu komprende Efeitus husi Tabaku ba Saude � Atu Koñese Bareiras no Dezafius atu kontrolu Tabaku iha Timor Leste � Atu Kompriende Estrategia kombate Tabaku iha Timor Leste
Baze Legal � Decreto Lei No 9 / 2006: Avisos de Saúde e Controlo Fiscal do Tabaco Manufacturados � Timor Leste asina ona Plataforma Konvensaun ba Kontrolu Tabaku iha loron 25 Maio 2004 (FCTC) no ratifika ona iha loron 22 Dezembru 2004 � Lejislasaun Tabaco Komprensivo Draf ona no sei submete ba konsellu ministro iha tempo badak. � Rejime publisidade ba Tabaku no alkohol 2011 � Planu estrategiku ba kontrolu Moras la Hada’et 2014 -2018
DNSP DSCD D. CDNC U. Idosos, Moras Cronica no Disabilidad e U. Saude Matan U. Saude Mental U. Saude Oral DPHO NCDC 13 DISTRITOS U. Prevensaun Injuria, Controlo Tabaco no Alcohol
INTRODUSAUN Globalmente Epidemia tabacco hamate ema besik miliaun 6 kada tinan Ø Mortalidade >600 000/tinan husi ema fumador pasivu. Ø Bainhira ita la foti asaun ruma, epidemia bele hamate ema liu husi miliaun 8 kada tinan iha 2030. Ø >80% husi menus halo prevensaun ba mortalidade mak ema ne’ebe moris iha nasaun sira nebe rendementu kiik inklui mos Timor leste Ø Industria tabaku iha maneira oi-oin hodi dada konsumedor foun sira hodi nune’e bele mantein no hasa’e fan tabaku no hetan lukru. Ø
60 M Non-Communicable Diseases (NCDs): 36 million deaths (63% of global mortality) 9% 50 M 28% 40 M; 30 M 20 M 47% 10 M 16% 0 Communicable, maternal, perinatal and nutritional conditions 2008 estimates NCDs < 60 NCDs > 60 Injuries
Low and middle income countries are the most affected 35 M 30 M 25 M 20 M 15 M 10 M 5 M 0 M Low-income Countries Communicable, conditions Lower- Middle-income Countries NCDs < 60 Upper. Middle-income Countries NCDs > 60 High-income Countries Injuries
The problem has a serious impact! NCDs �Have major adverse effects on the quality of life of affected individuals; �Cause premature deaths: ◦ 44% of NCD deaths occur at age <70 years �Create large adverse economic effects on families, communities and societies in general.
Prevention is possible Largest part of main NCDs can be prevented if risk factors are eliminated 20% 80% Heart disease 20% 80% Stroke 20% 60% 40% 80% Type 2 diabetes Cancer preventable not preventable
Substansia hirak ne’ebé maka perigu
Causal links NCDs Metabolic Risk Behavioral risk factors Raised BP Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Globalization Urbanization Population ageing Social determinants of health
Mekanismu oinsa tabaku aumenta risku ? �Radical livre—kauza oxidasaun ba plasma LDL �Aumenta LDL �Adesaun ba monosytos ba arteria/veias aumenta ateroesklerosis
Risk Factors Common to Major NCD Conditions Condition Cardiovascular diseases Diabetes Cancer Tobacco use √ √ √ Alcohol √ √ √ Low fruit & vegetable √ √ √ High dietary salt √ √ √ Physical Inactivity √ √ √ Obesity √ √ √ Raised blood pressure √ √ Raised blood glucose √ √ √ Abnormal blood lipids √ √ √ Respiratory Conditions √ √ √
Fumu oras ne’e daudaun iha adultu mane sira India (2009 -2010) Sri Lanka (2006) Nepal (2008) 24% 30% 36% Bangladesh (2009) 45% Myanmar (2009) 45% Thailand (2011) 47% Maldives (2009) 47% Indonesia (2011) Timor-Leste (2009 -2010) 67% 70%
Expozisaun ba fuma passivu iha uma maka entre labarik foin sa’e sira ho idade 13 -15 Africa South-East Asia Eastern Mediterranean Americas Global Western Pacific Timor Leste (2009) Europe 28% 34% 38% 41% 43% 51% 59% 78%
Prevalencia konsumo Tabaco no fator risku seluk iha Timor. Leste Timor Leste seidauk iha Informasaun seluk kona ba Tabaku iha tinan ida ne’e
Figure : Percent who have used any form of tobacco in the past 30 days - GYTS Timor-Leste 100. 0 2006 2009 2013 90. 0 80. 0 70. 0 Percentage 60. 0 50. 0 40. 0 68. 8 30. 0 48. 4 20. 0 41. 0 54. 5 39. 7 31. 1 29. 8 10. 0 32. 4 23. 8 0. 0 Total Boy Girl
Mortalidade no Morbilidade tanba MLH iha ospital Timor Leste (Jan-Dez 2012) Fonte: Relatóriu Anual Estatistika Saúde Admisaun/Baixa Kategoria Moras Númeru Mate % Moras La hada’et 17193 49. 9 Moras Kardiovaskular inklui Stroke 1307 3. 8 Diabetes Melitus 115 0. 3 Moras Respiratória Krónika 531 1. 5 Moras Hepátika no Renál 608 1. 8 Moras Nutrisionál 563 1. 6 Moras Mental no neurolójiku 183 0. 5 Kanek 1416 4. 1 Kauza moras la-definidu ka Laespesífiku 12504 36. 3 TOTAL 34420 100. 0 * La inklui mate fetal intrauterina Númeru % 272 22. 2 147 16 29 73 21 0 39 12. 0 1. 3 2. 4 6. 0 1. 7 0. 0 3. 2 626 1223* 51. 2 100. 0
The UN High-level Meeting Konaba Moras Lahadaet NCDs (New York, 19 -20 September 2011) • Badala rua isu saude diskuti husi Estadus Unidus Asembleia Geral (UN GA) • Atende husi Ulun Boot nasaun 113 • Chefe Nasaun ka representativu Hamosu: Declarasaun Politika
Moras La Hadaet iha Timor. Leste �Moras oin rua mak mosu– Moras Hadaet komesa tun neneik no Moras La Hadaet komesa sae neneik � 30% husi pasient moras baixa iha hospital no mate tamba moras sira Lahadaet �Numeru arkivu Hospital hatudu katak moras lahadaet aumenta no pasiente nia tinan menus ba bebeik. �Afeita ba profuktividade ekonomia durante periodu moris. �Pasiente nebe refere ba nasun seluk hatudu gastu makas iha orsamentu Saude.
Prevensaun & controla Moras Lahadaet (NCD): Framework Simples Hahalok sira nebe bele muda: • Tobacco • La halo actividade Physico • Dieta nebe la saudavel ( masin, bokur & midar, afuan/modo) Strategia ba Populasaun: • Envairomentu • Regulamentu/Lei • Edukasaun Pathophysiological Fator Risku • Tensaun As • Kolesterol As • Diabetes • Bokur liu • Atakasaun moras Fuan • Stroke • Diabetes • Cancers • Moras Kroniku Respiratoria Kustu efektivu tx • Screening no tratamentu ba kasu mora la hadaet akut ba ema risku Strategia ba Risk-As: Prevensaun Primaria (Hamenus incidensia kasu-kasu foun) + Surveillance • Matadalan & halao evaluasaun ba intervensaun
Komponentes husi Sigaru suar Componente Concentración media por pitillo Alquitrán 1 -40 mg Nicotina 1 -2. 5 mg Fenol Catecol Pireno Benzo (a) pireno 2. 4 Dimetilfenol m- y p-Cresol p-Etilfenol Sigmasterol Fitosteroles (toal) 20 -150 mg 130 -280 mg 50 -200 mg 20 -40 mg 49 mg 20 mg 18 mg 53 mg 130 mg Seluk tan
Relasaun Tabaco ho Saúde q Sigaru suar nia kontenidu iha sustancia >4000 substancias quimicas : Nicotina, no > 60 Cansirigenos (Provoca Kankru) q Substancia hanesan monóxido de carbono, alquitrán, arsénico no plomo toxiku ba ita nia isin. q Nicotina hanesan Droga Psikoativa ne’ebe provoka Toleransia no Dependensia (Ketagihan) q Hanesan substancia Hidrosoluble ne’ebe absorbe direitamente husi ita nia ibun no vias respiratorias, ran, Aten, Bazo no kakutak q Sigaru nia suar iha Monoxido de Carbono provoca disfunsaun endotelial Generalizada no provoca ateroesclerosis (Sulan uat) q Efeitus Cigarus aumenta Estimulos Nervoso simpatiku, Libera Adrenalina halo oat sai klot no Aumenta Tensaun Arterial
Efeitus husi Tabacco ba Saúde v. Fuma no Hasae Risku ba Saude Ø Moras coronaria (fuan) dala 2 to’o dala 4 Ø Stroke dala 2 to’o dala 4, Ø Mane dezenvolve kankru aten bo’ok to’o dala 23 Ø Desenvolvementu kankru ba Feto to’o dala 13 Ø Hamosu moras respirasaun Kroniku(hanesan Bronquitis Kronika, Enfisema, Asma) dala 12 to’o dala 13.
Moras Kankru �Kanker iha ibun “Cancer of the oral cavity (mouth)” �Kanker iha Aten Book (Lung cancer) �Kankru iha ran (Acute myeloid leukemia) �Kanker Mamik (Bladder cancer) �Kanker iha Servikal (Cancer of the cervix) �Kanker iha Esofagus (Cancer of the esophagus) �Kanker iha Rins (Kidney cancer) �Kanker iha Laringe “Cancer of the larynx (voice box)” �Kanker iha Pharinx “Cancer of the pharynx (throat)” �Kanker iha Pankreas (Pancreatic cancer) �Kaker iha kabun (Stomach cancer)
Types of Cancers l Carcinomas (cells that cover internal and external body surfaces) Lung Breast Leukemia (Blood Cells) Lymphomas (Lymph nodes &tissues) Colon Bladder Prostate (Men) Sarcomas Cells in supportive tissues – bones & muscles
Ø Efeitu Seluk husi Tabaku �La iha fertilidade (Laiha oan) �Partus antes (preterm delivery), �Moris mate (stillbirth), �Bebe moris ho todan menus (low birth weight), no �Sinais mate derepente ba bebe depois partus “sudden infant death syndrome (SIDS)”. �Malformasaun konjenita
Moras vaskular no moras seluk
Risku maka’as ba ataka kurasaun BA DALA RUA BELE MATE
Feto sira Fuma bele aumenta liútan oportunidade ba abortu
Maski horon fuma uitoan ida mos perigu Laíha nível seguru ba expozisaun ba Fumu Pasivu • Fumu Passivu maka kauza boot ida ba moras fuan, estrok, moras respirasaun, kankru pulmaun, no seluk tan. • Maski so expozisaun 30 minutu de’it ba fuma passivu, produz reasaun fiziku hirak ne’ebé hanesan ne’ebé sei mosu husi fuma ba longu prazu, no aumenta risku ba moras fuan ba ema sira ne’ebé la fuma. • Aumentu ida iha risku ba kankru pulmaun ba ema sira ne’ebé la fuma ne’ebé hetan expozisaun ba fumu passivu iha 20% iha feto no 30% iha mane sira. • Ema sira ne’ebé la fuma ne’ebé hetan expozisaun ba Fumu Passivu iha serbisu fatin iha aumentu husi 16 to’o 19% iha risku husi dezenvolve kankru. • Rizku husi hetan kankru pulmaun aumenta depende
Lakuna �
Dezafios ba Saúde Pública 1. Merkado livre/Globalizasaun 2. Moris Moderna ( Stilos Moris la saúdavel ) 3. Sosiokultura ( Tradisaun moris rai nian ) 4. Asesu Tabaco ne’ebe libre tebes ba populasaun ho idade hotu-hotu.
Estratejia Nasional ba Kontrolu no Prevensaun ba Moras la Hada’et 2014 -2018 D: PLANU ESTRATEGIKU NCDC TRADUZIDUPLANU ESTRATEJIKU NCDC PREPARA BA TRADUSAUN_RevisaunPlanu Estratejiku NCDC FinalFinal NCD Strategy cum Action Plan 2014 -18 - Copy. pdf
Vision �“Ema Timor oan hotu bele Goja moris saudavel no moris produktivu no livre husi moras, disabilidade no mate sedu relasiona ho Moras La Hadaet
Estrategia Nacional ba kontrolu Tabaku Advokasia no Lideransa ba resposta husi multi-setoral 2. Promosaun Saude no Prevensaun Primaria 3. Haforsa sistema saude 4. Surveilencia, Monitorizasaun, Evaluasaun no Pesquija 1.
Estrategia ba no prevensaun no kontrolu Tabaku � Introdusaun komprensivu ba lejizlasaun ne'ebé relasiona ho tabaku hodi tau iha kompromisu tuir Konvensaun Enkuadramentu kona-ba Kontrola Tabaku (FCTC) no obriga ninia implementasaun. ◦ Hasa’e impostu kona-ba produtu tabaku inklui taxa importasaun. ◦ Deklara fatin públiku hotu livre tabaku ◦ Halo obrigatoriedade avizu saúde ho imajen iha produtu tabaku ◦ Implementa bandu ka proibisaun komprensivu ba iha publisidade tabaku iha mídia no liu husi Orgaun legal, patrosíniu no promosaun. ◦ Bandu fa’an tabaku ba no husi otas sei ki’ik.
� Harii sistema vijilánsia tabaku nian hodi monitoriza ninia uzu inklui entre adolesente sira. � Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira. � Hala’o kampaña mídia hodi responde hasoru influensia husi industria tabaku no dezenkoraja uza tabaku. � Backup of PROPOSTA DE LEI DO TABACO, Versao Ultimada 15 -09 -14. docx � Proposta RCT 14 -11 -2014. pptx
Advokasia Política saudável Edukasaun Saúde Muda hahalok Hili Hahalok saudável hanesan ‘ fasil’ atu hili
Asaun Multisetoral no Interministerial Advokasia / Akonsellamentu � Mudanca hahalok ema lubun ida � Harii sistema vijilánsia tabaku nian hodi monitoriza ninia uzu inklui entre adolesente sira. � Estabelese Servisu Hapara Tabaku iha fasilidade saúde sira. Politica no Regulamentu � Limitasaun ba Manufaktura � Hasa’e Taxa • Limitasaun husi publisidade • Regulamento ba faan sigaru • Avizu saúde iha label sigaru • Fatin publiku livre husi sigaru • Bandu fa’an tabaku ba no husi otas sei ki’ik. Komprimentu: kompriende no halo mundansa livre husi fuma
Kolaborasaun Interministerial no multisektoral hodi kontrola Tabaku iha Timor Leste � Ministerio Saude �Instituisaun Privadu � Ministerio Edukasaun �Sociendade Sivil � Ministerio Justisa � Ministerio Agrikultura � MTCI � SEJD � Sec. Estado Com. Social � Sec Est. Seguransa � Media � etc �NGO �Igreja
Haforsa Sistema Saúde �Haforsa kapasidade rekursu humano iha nivel hotu sistema saude �Fo kontinuasaun servisu liu husi sistema referal inklui tratamentu tersiaria �Establese servisu tratamentu tersiaria iha Hospital Nasional ba moras Fuan, moras rins, stroke no kankru. �Desenvolve solusaun inovativa atu kobre kustu inklui realokasaun husi taxa ba atividade promosaun saude �Estabelese Akonselamentu hapara tabaku (Tobacco Sesasion services)
Survelencia, Monitoriza, Evaluasaun & Pesquiza Ø Halao Survey ba Fator Risku NCDs kada tinan 5 Ø Identifika area sira iha Estudu Demografia Saude (DHS) atu involve dadus Peskiza ba Tabaco. Ø Haforsa Sistema Informasaun Saude hodi fo suporta ba foti desijaun Ø Atu haforsa peskisa relasiona ho Fator risku
Kankru iha Ibun
PREVENE ESTILO DE VIDA LA SAUDAVEL
PREVENE ESTILO DE VIDA LA SAUDAVEL
PROMOVE ESTILO DE VIDA SAUDAVEL
OBRIGADO WAIN
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