National NCD Situation and Response Tania Alfaro Morgado

Basic Indicators • Estimated population (2010): 17. 094. 275 • Gross Domestic Product (GDP)

Our Health System Ministry of Health Consejos Subsecretaría de Salud Pública ISP Superintendencia de

Our situation in health Causes (Source: DEIS) 1 2 3 4 Both Males Females

Cardiovascular Disease High risk and very high risk National: 54. 9% Males: 64. 2%

Our efforts (1) • Improve health goals reached • Decrease inequalities in health •

Our efforts (2) • Health sector reform: Explicit Guarantees to Health (GES) o Contains

Our efforts (3): Some specifics strategies • Noncommunicable Diseases Department (2004) • Cardiovascular Health

Our efforts (4): Some specifics strategies • Surveillance: Noncommunicable Diseases´ Surveillance and Studies Unit

Challenge in Health • Reducing the inequalities in health • Emphasizing the promotion of

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National NCD Situation and Response Tania Alfaro Morgado Department of Epidemiology Ministry of Health of Chile Seminar on Public Health Aspects of NCD, Lausanne, 10 -18 August, 2010 de Ministerio Salud

Ministerio de Salud

Basic Indicators • Estimated population (2010): 17. 094. 275 • Gross Domestic Product (GDP) per capita (2009): U$14. 700 • Spending in health(2008): 6, 9% of GDP Ministerio de Salud

Our Health System Ministry of Health Consejos Subsecretaría de Salud Pública ISP Superintendencia de Salud Subsecretaría de Redes Asistenciales SEREMI CENABAST FONASA Laboratorios ISAPRES Prestadores Privados Servicios de Salud (RED) APS Municipal Otros Establecimientos del Servicio Otras Actividades Reguladas Hospitales Autogestión en Red Ministerio de Salud

Our situation in health Causes (Source: DEIS) 1 2 3 4 Both Males Females Rate Nº % Rate Nº • Life expectancy of birth (2008): average 78, 45 years (male: Ischemic heart diseases 48. 3 7. 943 9. 3 57. 6 4, 685 10. 2 39. 3 3, 258 75, 49 years; female: 81, 53 years) Cerebrovascular diseases 46. 3 7. 608 45. 6 3, 708 8. 1 • Mortality rate (2006): 5. 2 per 8. 9 1. 000 population 47. 0 % 8. 2 3, 900 9. 8 24. 0 studie 3. 947 (2007): 4. 6 23. 2 4. 1 because 24. 8 2, 056 • Burden of Diseases´ 84%1, 891 of DALYs Cirrhosis of theattributable liver and other NCD; mortality to 4. 1 risk 31. 6 factors liver diseases 21. 6 3. 550 2, 568 5. 6 13, 4 1, 108 5. 2 Other heart diseases • National Health Survey (2003): 20. 3 3. 335 3. 9 5 Diabetes mellitus 6 Hypertensive diseases 7 Stomach cancer 8 Pneumonia Bronchitis, emphysema and other chronic obstructive 9 pulmonary diseases Tracheal, bronchial and lung 10 cancer 2. 8 19. 9 1, 617 3. 5 20. 7 1, 718 4. 3 18. 9 3. 110 3. 6 16, 0 1, 301 2. 8 21. 8 1, 809 4. 6 18. 9 18. 1 3. 109 2. 973 3. 6 3. 5 26. 3 17. 4 2, 137 1, 416 4. 6 3. 1 11, 7 18. 8 972 1, 557 2. 5 3. 9 16. 5 2. 707 3. 2 18, 1 1, 470 3. 2 14. 9 1, 237 3. 1 14. 7 2. 411 2. 8 18. 9 1, 540 3. 3 10, 5 871 2. 2 Ministerio de Salud

Cardiovascular Disease High risk and very high risk National: 54. 9% Males: 64. 2% Females: 46. 2% Source: National Health Survey, 2003, Ministry of Health, Chile Ministerio de Salud

Our efforts (1) • Improve health goals reached • Decrease inequalities in health • Face challenges of aging of the population and of change in society • Provide services according population´s expectations Ministerio de Salud

Our efforts (2) • Health sector reform: Explicit Guarantees to Health (GES) o Contains access, opportunity, quality and financial protection o More than 60 health problems included (2010) 2009: 80% of spending in GES because of NCD Cases Spending (59%) Health problem o Health problems • 56 Evaluation of National (N°) (MM US$) 890 Health 4. 234. 295 Objectives (2009) Chronic Diseases 2. 512. 298 • 34 National Plan of Health in process (2010) % of participation 59% 708 80% Ministerio de Salud

Our efforts (3): Some specifics strategies • Noncommunicable Diseases Department (2004) • Cardiovascular Health Program: cardiovascular risk factors in one program 1, 200, 000 400, 000 30 1, 000 300, 000 25 800, 000 200, 000 15 20 600, 000 100, 000 400, 000 200, 000 10 5 0 0 2002 2003 2004 2005 2006 2007 2008 2009 Año 0 2002 2003 PBC DM Tipo 2 PBC HTA 2004 2005 Compensados 40 % N° 1, 600, 000 • Cancer program: cervical cancer screening (1987)---GES 45 60 40 1, 400, 000 50 (2010) 35 30 20 10 00 2008 2009 % Compensacion Hb. A 1 c < 7 % Compensacion P/A <130/85 Ministerio de Salud

Our efforts (4): Some specifics strategies • Surveillance: Noncommunicable Diseases´ Surveillance and Studies Unit (2004) in the Department of Epidemiology o Research: Burden of Disease, Quality of Life, National Health Survey, GYTS o Cancer registries : national childhood cancer registry and population –based cancer registries (Valdivia and Antofagasta) o System of surveillance by intoxication of pesticides (REVEP) Ministerio de Salud

Challenge in Health • Reducing the inequalities in health • Emphasizing the promotion of health • Improving the primary care system Ministerio de Salud